1609037134 NPI number — COBORNS INC

Table of content: (NPI 1609037134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609037134 NPI number — COBORNS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COBORNS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CASH WISE CLINIC PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609037134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6146
Provider Second Line Business Mailing Address:
PO BOX 6146
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56302-6146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-534-2745
Provider Business Mailing Address Fax Number:
320-203-1095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 PETERSON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56273-7823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-354-3998
Provider Business Practice Location Address Fax Number:
320-354-3997
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

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:
320-354-2743

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 263191 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609037134 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2049512 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com