Provider Demographics
NPI:1346398815
Name:LIMAS PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:LIMAS PROFESSIONAL PHARMACY
Other - Org Name:LIMAS PROFESSIONAL PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:707-441-8530
Mailing Address - Street 1:1711 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3601
Mailing Address - Country:US
Mailing Address - Phone:707-839-8500
Mailing Address - Fax:707-839-2867
Practice Address - Street 1:1711 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3601
Practice Address - Country:US
Practice Address - Phone:707-839-8500
Practice Address - Fax:707-839-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43125183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0578584OtherNABP
CAPHA431250Medicaid
CA1223580001Medicare NSC