Provider Demographics
NPI:1710314844
Name:LIM, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 HWY 213
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0000
Mailing Address - Country:US
Mailing Address - Phone:503-451-7961
Mailing Address - Fax:503-451-7995
Practice Address - Street 1:17901 HWY 213
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-0000
Practice Address - Country:US
Practice Address - Phone:503-451-7961
Practice Address - Fax:503-451-7995
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist