Provider Demographics
NPI:1073102802
Name:LIM, ANNIE (RPH)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 SANTA MONICA BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1991
Mailing Address - Country:US
Mailing Address - Phone:310-315-9999
Mailing Address - Fax:
Practice Address - Street 1:1908 SANTA MONICA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1991
Practice Address - Country:US
Practice Address - Phone:310-315-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH79495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist