Provider Demographics
NPI:1083166870
Name:LIM, AMBER RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:LIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6116 E PEA RIDGE RD
Mailing Address - Street 2:APT 46
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2358
Mailing Address - Country:US
Mailing Address - Phone:606-422-6071
Mailing Address - Fax:
Practice Address - Street 1:3801 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1527
Practice Address - Country:US
Practice Address - Phone:304-925-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist