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COBORNS INC NPI 1003260969


NPI Information

NPI: 1003260969
Provider Name: COBORNS INC

Doing Business As: MARKETPLACE PHARMACY #2583

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 52D2118398

Address:
10514 MAIN ST
HAYWARD, WI
ZIP 54843
Phone: (715) 634-1817
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COBORNS INC is a community/retail pharmacy pharmacy in Hayward, WI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. COBORNS INC NPI is 1003260969. The provider is registered as an organization entity type.
The provider Is Doing Business As Marketplace Pharmacy #2583.

The provider's business location address is:

10514 MAIN ST
HAYWARD, WI
ZIP 54843-720
Phone: (715) 634-1817
Fax: (855) 304-4787

The provider's authorized official is Chad Nellis .
The authorized official title is Director Of Pharmacy and has the following contact phone number (320) 534-2743.

The CLIA number assigned to this NPI record is 52D2118398 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2016 and was last updated on 10/2/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0004XPharmacyCompounding PharmacyNo
33336L0003XPharmacyLong Term Care PharmacyNo
4332B00000XDurable Medical Equipment & Medical SuppliesNo
53336C0003XPharmacyCommunity/Retail Pharmacy9403-42WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12159610OTHERPK
21000056023MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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