Provider Demographics
NPI:1124328935
Name:LIM, HEA- RAN
Entity type:Individual
Prefix:MRS
First Name:HEA- RAN
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 1:1620 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2434
Mailing Address - Country:US
Mailing Address - Phone:707-252-0170
Mailing Address - Fax:707-252-0278
Practice Address - Street 1:1620 CLAY ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2434
Practice Address - Country:US
Practice Address - Phone:707-252-0170
Practice Address - Fax:707-252-0278
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist