Provider Demographics
NPI:1861645426
Name:JORGENSON, JOSEPH NORMAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NORMAN
Last Name:JORGENSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 COUNTY ROAD E E
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-7333
Mailing Address - Country:US
Mailing Address - Phone:651-289-4300
Mailing Address - Fax:651-289-4301
Practice Address - Street 1:2008 COUNTY ROAD E E
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-7333
Practice Address - Country:US
Practice Address - Phone:651-289-4300
Practice Address - Fax:651-289-4301
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist