Healthcare Provider Details

I. General information

NPI: 1497635882
Provider Name (Legal Business Name): MARK JUSTIN ALVENDIA LIM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARK LIM RPH

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 S CICERO AVE
BEDFORD PARK IL
60638-6402
US

IV. Provider business mailing address

3108 N ODELL AVE
CHICAGO IL
60707-1239
US

V. Phone/Fax

Practice location:
  • Phone: 708-496-0230
  • Fax:
Mailing address:
  • Phone: 773-559-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.306852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: