Healthcare Provider Details

I. General information

NPI: 1548347180
Provider Name (Legal Business Name): LIMA'S PROFESSIONAL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 HARRISON AVE
EUREKA CA
95501-3211
US

IV. Provider business mailing address

2097 HARRISON AVE
EUREKA CA
95501-3211
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-8500
  • Fax: 707-443-7608
Mailing address:
  • Phone: 707-441-8500
  • Fax: 707-443-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43124
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY43124
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number99030
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT BREDE LIMA
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 707-441-8530