Provider Demographics
NPI:1134427974
Name:LIM, SHANNON S (RPH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:S
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 1:41 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2685
Mailing Address - Country:US
Mailing Address - Phone:302-678-2101
Mailing Address - Fax:302-678-5797
Practice Address - Street 1:41 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2685
Practice Address - Country:US
Practice Address - Phone:302-678-2101
Practice Address - Fax:302-678-5797
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist