NPIMap

Organization Active NPI

Coborns Inc

  • Community/Retail Pharmacy
  • Clearwater, MN
National Provider Identifier
1003989641
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
262607 Issued in MN
Legal business name
COBORNS INC
Practice address
705 County Road 75 NW
Clearwater, MN 55320-2070
Phone
(320) 558-2454
Fax
(320) 558-4575
NPI assigned
Nov 15, 2006
Organization subpart
Yes
Parent organization
COBORNS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lynn R Young, RPH
Title
Director of Pharmacy
Phone
(320) 534-2743

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 262607 MN Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

705 County Road 75 NW
Clearwater, MN 55320-2070

Mailing address

PO Box 6146
PO Box 6146
Saint Cloud, MN 56302-6146
Phone (320) 534-2745

Other identifiers 2

IdentifierTypeStateIssuer
2048578OtherPK
1003989641MedicaidMN

Other names 2

  • COBORN'S PHARMACY #2008 Doing business as
  • COBORNS PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071215000009 MN Part B Supplier - Mass Immunization (Roster Biller Only) 3072416593 35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Ulm, MN; Princeton, MN; Otsego, MN; Owatonna, MN; Park Rapids, MN; Pipestone, MN; Ramsey, MN; Saint Cloud, MN…
O20100930048264 MN DME Supplier - PharmacyDME Supplier - Grocery Store 3072416593 Practice locations: Clearwater, MN

Other NPIs on the same Medicare enrollment 34

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 34

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Coborn'S Pharmacy #2008705 County Road 75 NW, Clearwater, MN 55320-2070(320) 558-2454 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Urological Supplies|Nebulizer Equipment and/or Supplies|Surgical Dressings Accepts assignmentParticipating since Jan 1, 2016

National Provider Directory

National Provider Directory
Tax ID family
Coborn'S Pharmacy Service38 organizations share this tax ID, including this one
Part of
Coborn'S Pharmacy Service

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

705 County Road 75
Clearwater, MN 55320
Phone (320) 558-2454

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1003989641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6146",
            "address_2": "PO BOX 6146",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563026146",
            "telephone_number": "320-534-2745",
            "fax_number": "320-203-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 COUNTY ROAD 75 NW",
            "city": "CLEARWATER",
            "state": "MN",
            "postal_code": "553202070",
            "telephone_number": "320-558-2454",
            "fax_number": "320-558-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBORNS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COBORNS INC",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "320-534-2743",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262607",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048578",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003989641",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COBORN'S PHARMACY #2008",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COBORNS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clearwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.