Provider Demographics
NPI:1083996607
Name:LIM, TRICIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
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 1:3406 TIGER LILY DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9046
Mailing Address - Country:US
Mailing Address - Phone:734-369-3155
Mailing Address - Fax:
Practice Address - Street 1:3406 TIGER LILY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9046
Practice Address - Country:US
Practice Address - Phone:734-369-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029051183500000X
VA0202206814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist