Healthcare Provider Details

I. General information

NPI: 1144482134
Provider Name (Legal Business Name): JESSIE F LIM PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MONTECILLO RD PHARMACY
SAN RAFAEL CA
94903-3308
US

IV. Provider business mailing address

99 MONTECILLO RD PHARMACY
SAN RAFAEL CA
94903-3308
US

V. Phone/Fax

Practice location:
  • Phone: 415-444-2044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH40406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: