Marketplace Pharmacy #2583

LBN: Coborns Inc
Marketplace Pharmacy #2583 is an health care organization with primary practice located at 10514 Main St , Hayward WI 54843-6720. The organization recently has 5 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Coborns Inc can be contacted via phone (715) 634-1817, or through Nellis, Chad via phone (320) 534-2743.

Contact Information

Primary practice address
10514 Main St Hayward WI 54843-6720
Phone: (715) 634-1817
Fax: (855) 304-4787
Website:
Map and Directions
Authorized official contact:
Name: Nellis, Chad PHARMD
Phone: (320) 534-2743

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 9403-42 Wisconsin
Suppliers / Compounding Pharmacy 3336C0004X
Suppliers / Long Term Care Pharmacy 3336L0003X

Profile Details

NPI number 1003260969
LBN Legal business name Coborns Inc
DBA Doing business as Marketplace Pharmacy #2583
Authorized official Nellis, Chad PHARMD
Entity Organization
Organization subpart 1 Yes
Enumeration date Apr 18th, 2016
Last updated Oct 2nd, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003260969 NPPES
Other 2159610 PK
MEDICAID 1000056023 PK

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