Active NPI
Coborns Inc
Doing business as Coborn's Clinic Pharmacy # 2017
- Health Maintenance Organization
- Mora, MN
National Provider Identifier
1194101766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 119447
- Legal business name
- COBORNS INC
- Doing business as
- Coborn's Clinic Pharmacy # 2017
Coborn's Pharmacy #2017 - Practice address
- 710 Frankie LN
Mora, MN 55051-1914 - Phone
- (320) 679-2363
- Fax
- (320) 679-1620
- NPI assigned
- Aug 6, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 119447 | MN | Primary |
| 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 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831261502 | Medicaid | MN | |
| 2406987 | Other | NCPDP |
Other names 2
- COBORN'S CLINIC PHARMACY # 2017
- COBORN'S PHARMACY #2017
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
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": "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
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.