Provider Demographics
NPI:1902480650
Name:COBORNS INC
Entity Type:Organization
Organization Name:COBORNS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING/CREDENTIALING MGR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-534-2745
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:763-746-6593
Mailing Address - Fax:320-203-1095
Practice Address - Street 1:630 RYAN'S WAY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:56313
Practice Address - Country:US
Practice Address - Phone:320-534-2742
Practice Address - Fax:320-203-1095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBORNS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy