Provider Demographics
NPI:1427757087
Name:LIM, BORAM (RPH)
Entity type:Individual
Prefix:
First Name:BORAM
Middle Name:
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 1:7002 MOODY ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1181
Mailing Address - Country:US
Mailing Address - Phone:562-403-2332
Mailing Address - Fax:
Practice Address - Street 1:7002 MOODY ST STE 106
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1181
Practice Address - Country:US
Practice Address - Phone:562-403-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist