Provider Demographics
NPI:1528687712
Name:LIM, HEANG HENRY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEANG
Middle Name:HENRY
Last Name:LIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:306 MARSTON MILL WAY
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-7829
Mailing Address - Country:US
Mailing Address - Phone:270-535-0053
Mailing Address - Fax:
Practice Address - Street 1:3401 W END AVE STE 630
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6891
Practice Address - Country:US
Practice Address - Phone:615-875-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000040188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist