NPIMap

Organization Active NPI

Coborns Inc

Doing business as Coborn's Pharmacy #2030

  • Community/Retail Pharmacy
  • Park Rapids, MN
National Provider Identifier
1720150493
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
262190 Issued in MN
Legal business name
COBORNS INC
Doing business as
Coborn's Pharmacy #2030
Coborns Pharmacy
Practice address
209 1St St W
Park Rapids, MN 56470-1504
Phone
(218) 732-0836
Fax
(218) 732-0865
NPI assigned
Nov 15, 2006
Last updated
Aug 21, 2020By the provider in NPPES
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 NU
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 262190 MN Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

209 1St St W
Park Rapids, MN 56470-1504

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1720150493MedicaidMN
2048329OtherPK

Other names 2

  • COBORN'S PHARMACY #2030 Doing business as
  • COBORNS PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 34

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

View all 34

National Provider Directory

National Provider Directory
Part of
Coborns Inc

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, and the practitioner matching its NPPES authorized official.

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": "1720150493",
    "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": "209 1ST ST W",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701504",
            "telephone_number": "218-732-0836",
            "fax_number": "218-732-0865"
        }
    ],
    "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": "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": "262190",
            "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": "1720150493",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048329",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COBORN'S PHARMACY #2030",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COBORNS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COBORNS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park Rapids, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.