Provider Demographics
NPI:1457074643
Name:LIM, HEESEUNG JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEESEUNG
Middle Name:JENNIFER
Last Name:LIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HEESEUNG
Other - Middle Name:JENNIFER
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1625 EDGEWORTH BND APT 831
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4095
Mailing Address - Country:US
Mailing Address - Phone:201-800-2117
Mailing Address - Fax:
Practice Address - Street 1:3702 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6304
Practice Address - Country:US
Practice Address - Phone:512-651-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist