Provider Demographics
NPI:1033745302
Name:LIM, MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-3025
Mailing Address - Country:US
Mailing Address - Phone:800-443-4313
Mailing Address - Fax:
Practice Address - Street 1:4500 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-3025
Practice Address - Country:US
Practice Address - Phone:800-443-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty