Healthcare Provider Details

I. General information

NPI: 1346319860
Provider Name (Legal Business Name): ERIC W NORBERG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VILLAGE GREEN WAY
SOUTHWEST HARBOR ME
04679
US

IV. Provider business mailing address

PO BOX 1306
SOUTHWEST HARBOR ME
04679-1306
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5588
  • Fax: 207-244-5718
Mailing address:
  • Phone: 207-244-5588
  • Fax: 207-244-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR4284
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: