Provider Demographics
NPI:1780900860
Name:LIM, LAWRENCE M
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 PEBBLE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2148
Mailing Address - Country:US
Mailing Address - Phone:610-240-9987
Mailing Address - Fax:
Practice Address - Street 1:175 EAGLEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-3060
Practice Address - Country:US
Practice Address - Phone:610-363-0554
Practice Address - Fax:610-363-6583
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036693L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP036693LOtherSTATE LICENSE