Active NPI
Coborns Inc
Doing business as Coborn's Central Support Pharmacy #9942
- Community/Retail Pharmacy
- Sauk Rapids, MN
National Provider Identifier
1124684634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- COBORNS INC
- Doing business as
- Coborn's Central Support Pharmacy #9942
- Practice address
- 110 1St St S Ste C
Sauk Rapids, MN 56379-1404 - Phone
- (320) 202-8343
- Fax
- (320) 202-8341
- NPI assigned
- May 10, 2019
- Last updated
- Aug 3, 2022
- 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
- Chad Nellis, PHARMD
- Title
- Director of Pharmacy
- Phone
- (320) 534-2743
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary | ||
| Mail Order Pharmacy | 3336M0002X |
Addresses
Primary practice location
110 1St St S Ste C
Sauk Rapids, MN 56379-1404
Mailing address
PO Box 6146
Saint Cloud, MN 56302-6146
Phone (320) 534-2745
Other practice location 1
1921 Coborn Blvd
Pharmacy Office
Saint Cloud, MN 56301-6146
Phone (320) 534-2745
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2434532 | Other | NCPDP | |
| 1124684634 | Other | NPI |
Other names 1
- Coborn's Central Support Pharmacy #9942
National Provider Directory
National Provider Directory- Tax ID family
- Coborn's Pharmacy Service
- 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.
-
dba Coborn's Clinic Pharmacy # 2017
- Health Maintenance Organization
- Mora, MN
- NPI 1194101766
Locations
1921 Coborn Blvd
Ofc
Saint Cloud, MN 56301
Phone (320) 534-2745
110 1st St S
Ste C
Sauk Rapids, MN 56379
Phone (320) 202-8343
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": "1557446400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1659484800000",
"number": "1124684634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6146",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563026146",
"telephone_number": "320-534-2745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 1ST ST S STE C",
"city": "SAUK RAPIDS",
"state": "MN",
"postal_code": "563791404",
"telephone_number": "320-202-8343",
"fax_number": "320-202-8341"
}
],
"practiceLocations": [
{
"address_1": "1921 Coborn Blvd",
"address_2": "Pharmacy Office",
"address_purpose": "LOCATION",
"city": "Saint Cloud",
"state": "MN",
"postal_code": "563016146",
"country_code": "US",
"telephone_number": "320-534-2745",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "COBORNS INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COBORNS INC",
"enumeration_date": "2019-05-10",
"last_updated": "2022-08-03",
"certification_date": "2022-08-03",
"status": "A",
"authorized_official_last_name": "NELLIS",
"authorized_official_first_name": "CHAD",
"authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
"authorized_official_telephone_number": "320-534-2743",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336M0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Mail Order Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "2434532",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1124684634",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Coborn's Central Support Pharmacy #9942",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Coborn's Central Support Pharmacy #9942",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sauk Rapids, MN
- Cherrywood Advanced Living, LLC
- Cherrywood Advanced Living, LLC
- Christopher Mertensotto DDS, PLLC (Pearl Dental)
- Tamara Jean Christopherson
- Anna Clavin
- Coborns Inc (Coborn's Specialty pharmacy #1703)
- Coborns Inc (Coborn's Pharmacy #2001)
- Coborns Inc (Coborn's Pharmacy Services #1702)
- Coborns Inc (Coborn's Pharmacy #2001)
- Community Care Clinics of Minnesota (Community Care Clinics of Minnesota - Access Transportation Services)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.