Provider Demographics
NPI:1811501356
Name:COBORNS INC
Entity type:Organization
Organization Name:COBORNS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAULI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-534-2742
Mailing Address - Street 1:PO BOX 6146
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-6146
Mailing Address - Country:US
Mailing Address - Phone:320-534-2745
Mailing Address - Fax:320-203-1095
Practice Address - Street 1:110 1ST ST S
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:800-548-2568
Practice Address - Fax:855-456-8162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBORNS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811501356OtherNPI
2421066OtherNCPDP
MN261025OtherSTATE LICENSE
1386716058OtherNPI
2435166OtherNCPDP
2435166OtherNCPDP
BC3829693OtherDEA