Provider Demographics
NPI:1699373522
Name:NORBERG, LINNAE JO (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:LINNAE
Middle Name:JO
Last Name:NORBERG
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7194 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-9497
Mailing Address - Country:US
Mailing Address - Phone:320-224-9302
Mailing Address - Fax:
Practice Address - Street 1:9320 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4522
Practice Address - Country:US
Practice Address - Phone:763-295-9813
Practice Address - Fax:763-295-9815
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist