Provider Demographics
NPI:1528374980
Name:LIM, HANS IGNATIUS (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:HANS
Middle Name:IGNATIUS
Last Name:LIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:HNAS
Other - Middle Name:IGNATIUS
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:27177 HIGHWAY189
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:91784
Mailing Address - Country:US
Mailing Address - Phone:909-336-1275
Mailing Address - Fax:909-337-0791
Practice Address - Street 1:27177 HIGHWAY189
Practice Address - Street 2:E
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317
Practice Address - Country:US
Practice Address - Phone:909-336-1275
Practice Address - Fax:909-337-0791
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist