Provider Demographics
NPI:1598032179
Name:NORBECK, JEFF SCOTT
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:SCOTT
Last Name:NORBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 N RAINBOW FARM RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9464
Mailing Address - Country:US
Mailing Address - Phone:479-616-0230
Mailing Address - Fax:
Practice Address - Street 1:3499 BELLA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-5740
Practice Address - Country:US
Practice Address - Phone:479-273-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist