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Coborns Inc

Organization Active NPI Health Maintenance Organization · Mora, MN

NPI 1194101766 · NPPES record last updated Aug 21, 2020

Key facts

NPI
1194101766
Entity type
Organization (NPI type 2)
Primary specialty
Health Maintenance Organization 302R00000X
License
119447 (MN)
Legal business name
COBORNS INC
Practice address
710 Frankie LN
Mora, MN 55051-1914
Phone
(320) 679-2363
Fax
(320) 679-1620
NPI assigned
Aug 6, 2015
Organization subpart
Yes
Parent organization (as reported)
COBORNS INC

Authorized official

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

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.

Corporate family (same tax ID) 37

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

View all 37

National Provider Directory

Tax ID family
Coborn'S Pharmacy Service (38 organizations share this tax ID)
Part of
Coborn'S Pharmacy Service

Locations

710 Frankie Ln
Mora, MN 55051
Phone (320) 679-2363

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 119447 MN Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

710 Frankie LN
Mora, MN 55051-1914

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1831261502MedicaidMN
2406987OtherNCPDP

Other names

  • COBORN'S CLINIC PHARMACY # 2017 Doing business as
  • COBORN'S PHARMACY #2017 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 21, 2020.

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1194101766",
    "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",
            "fax_number": "320-203-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 FRANKIE LN",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511914",
            "telephone_number": "320-679-2363",
            "fax_number": "320-679-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBORNS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COBORNS INC",
        "enumeration_date": "2015-08-06",
        "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": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MN",
            "license": "119447",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831261502",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2406987",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COBORN'S CLINIC PHARMACY # 2017",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COBORN'S PHARMACY #2017",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mora, MN

All providers in Mora, MN · Health Maintenance Organization in Minnesota

Sources for this page

Verify at the official NPI Registry.