Provider Demographics
NPI:1699057208
Name:LIBERATO-LIM, JUSTINE ANN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ANN
Last Name:LIBERATO-LIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11450 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1917
Mailing Address - Country:US
Mailing Address - Phone:510-233-8405
Mailing Address - Fax:
Practice Address - Street 1:11450 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1917
Practice Address - Country:US
Practice Address - Phone:510-233-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019419183500000X
CA71832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist