Provider Demographics
NPI:1710577937
Name:NORBERG, JAY MICHAEL
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:MICHAEL
Last Name:NORBERG
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 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1651
Mailing Address - Country:US
Mailing Address - Phone:507-825-3100
Mailing Address - Fax:507-825-5810
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1651
Practice Address - Country:US
Practice Address - Phone:507-825-3100
Practice Address - Fax:507-825-5810
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17726183500000X
MN115498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1710577937Medicaid