Provider Demographics
NPI:1497635882
Name:LIM, MARK JUSTIN ALVENDIA (RPH)
Entity type:Individual
Prefix:
First Name:MARK JUSTIN
Middle Name:ALVENDIA
Last Name:LIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3108 N ODELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-1239
Mailing Address - Country:US
Mailing Address - Phone:773-559-0707
Mailing Address - Fax:
Practice Address - Street 1:7050 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6402
Practice Address - Country:US
Practice Address - Phone:708-496-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist