Provider Demographics
NPI:1255611109
Name:SIM, LYDIA KRIN (RPH)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:KRIN
Last Name:SIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:KRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-7948
Mailing Address - Fax:562-933-8785
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-328-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2021-03-09
Deactivation Date:2017-04-28
Deactivation Code:
Reactivation Date:2021-02-24
Provider Licenses
StateLicense IDTaxonomies
CA65633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist