Provider Demographics
NPI:1326823766
Name:COBORNS INC
Entity Type:Organization
Organization Name:COBORNS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:320-534-2743
Mailing Address - Street 1:1921 COBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-2100
Mailing Address - Country:US
Mailing Address - Phone:320-534-2747
Mailing Address - Fax:
Practice Address - Street 1:110 1ST ST S STE D
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1453
Practice Address - Country:US
Practice Address - Phone:320-258-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBORNS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-25
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy