Active NPI
Coborns Inc
Doing business as Coborn's Pharmacy #2038
- Community/Retail Pharmacy
- New Prague, MN
National Provider Identifier
1033384102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 263169
- Legal business name
- COBORNS INC
- Doing business as
- Coborn's Pharmacy #2038
Coborns Pharmacy - Practice address
- 200 Alton Ave SE
New Prague, MN 56071-5507 - Phone
- (952) 758-3132
- Fax
- (952) 758-8754
- NPI assigned
- Apr 29, 2008
- Last updated
- Aug 21, 2020
- Organization subpart
- Yes
- Parent organization
- COBORNS INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Lynn R Young, RPH
- Title
- Director of Pharmacy
- Phone
- (320) 534-2743
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Customized Equipment (DME) | 332BC3200X | NU | ||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 263169 | MN | Primary |
| Long Term Care Pharmacy | 3336L0003X | NU |
Addresses
Primary practice location
200 Alton Ave SE
New Prague, MN 56071-5507
Mailing address
PO Box 6146
PO Box 6146
Saint Cloud, MN 56302-6146
Phone (320) 534-2745
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033384102 | Medicaid | MN | |
| 2049498 | Other | PK |
Other names 2
- COBORN'S PHARMACY #2038
- COBORNS PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20100930092467 | MN | DME Supplier - Pharmacy | 3072416593 | Practice locations: New Prague, MN |
Other NPIs on the same Medicare enrollment 34
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Coborn's Pharmacy #2022
- Community/Retail Pharmacy
- Sauk Centre, MN
- NPI 1003988775
O20071215000009
-
dba Coborn's Pharmacy #2008
- Community/Retail Pharmacy
- Clearwater, MN
- NPI 1003989641
O20071215000009
-
dba Coborn's Pharmacy #2046
- Community/Retail Pharmacy
- Isanti, MN
- NPI 1144676370
O20071215000009
-
dba Coborn's Pharmacy #2042
- Community/Retail Pharmacy
- Belle Plaine, MN
- NPI 1154622991
O20071215000009
-
dba Cash Wise Pharmacy
- Community/Retail Pharmacy
- Willmar, MN
- NPI 1174622955
O20071215000009
-
dba Coborn's Pharmacy #2007
- Community/Retail Pharmacy
- Sartell, MN
- NPI 1194898734
O20071215000009
-
dba Cash Wise Pharmacy
- Community/Retail Pharmacy
- Moorhead, MN
- NPI 1376615047
O20071215000009
-
dba Coborn's Pharmacy #2001
- Community/Retail Pharmacy
- Sauk Rapids, MN
- NPI 1386716058
O20071215000009
-
dba Coborns Pharmacy
- Community/Retail Pharmacy
- Big Lake, MN
- NPI 1386717924
O20071215000009
-
dba Coborns Pharmacy #2037
- Community/Retail Pharmacy
- Hastings, MN
- NPI 1447447644
O20071215000009
-
dba Coborn's Pharmacy #2016
- Community/Retail Pharmacy
- Long Prairie, MN
- NPI 1457423121
O20071215000009
-
dba Coborn's Pharmacy #2019
- Community/Retail Pharmacy
- Princeton, MN
- NPI 1467524132
O20071215000009
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D1083108 | Coborn's Pharmacy #2038 | Certificate of waiver | Oct 14, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Coborn's Pharmacy #38 | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Nebulizer Equipment and/or Supplies | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Coborns Inc
- Part of
- Coborns Inc
Other organizations with this tax ID 37
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Coborn's Central Support Pharmacy #9942
- Community/Retail Pharmacy
- Sauk Rapids, MN
- NPI 1124684634
-
dba Coborn's Clinic Pharmacy # 2017
- Health Maintenance Organization
- Mora, MN
- NPI 1194101766
Locations
200 Alton Ave SE
New Prague, MN 56071
Phone (952) 758-3132
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1597968000000",
"number": "1033384102",
"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": "200 ALTON AVE SE",
"city": "NEW PRAGUE",
"state": "MN",
"postal_code": "560715507",
"telephone_number": "952-758-3132",
"fax_number": "952-758-8754"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COBORNS INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COBORNS INC",
"enumeration_date": "2008-04-29",
"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_name_prefix": "Ms.",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "332BC3200X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "332BP3500X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MN",
"license": "263169",
"primary": true
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1033384102",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2049498",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "COBORN'S PHARMACY #2038",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "COBORNS PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in New Prague, 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.