{
  "npi": "1831261502",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "RPh",
    "authorized_official_first_name": "LYNN",
    "authorized_official_last_name": "YOUNG",
    "authorized_official_middle_name": "R",
    "authorized_official_telephone_number": "3205342743",
    "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
    "certification_date": "2020-08-21",
    "enumeration_date": "2006-11-15",
    "last_updated": "2020-08-21",
    "organization_name": "COBORNS INC",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "COBORNS INC",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "710 FRANKIE LN",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "MORA",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "320-679-1620",
      "postal_code": "550511914",
      "state": "MN",
      "telephone_number": "320-679-2363"
    },
    {
      "address_1": "PO BOX 6146",
      "address_2": "PO BOX 6146",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "SAINT CLOUD",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "320-203-1095",
      "postal_code": "563026146",
      "state": "MN",
      "telephone_number": "320-534-2745"
    }
  ],
  "taxonomies": [
    {
      "code": "3336L0003X",
      "desc": "Pharmacy, Long Term Care Pharmacy",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "332BC3200X",
      "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "332BP3500X",
      "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "333600000X",
      "desc": "Pharmacy",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "3336C0003X",
      "desc": "Pharmacy, Community/Retail Pharmacy",
      "license": "261446",
      "primary": true,
      "state": "MN",
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "58",
        "medicare_type": "Medical Supply Company with Pharmacist"
      },
      {
        "medicare_code": "A5",
        "medicare_type": "Pharmacy"
      }
    ]
  }
}