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General NPI Number Information
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NPI Number | 1669569810
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Entity Type | Organization
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Legal Business Name | P.S. ENTERPRISE, INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 2300 HUNTINGTON DR
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City | SAN MARINO
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State | CA
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Zip | 91108-2641
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Country | US
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Telephone | 626-287-9921
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Fax | 626-285-0644
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Provider Business Mailing Address
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Address Line | 2300 HUNTINGTON DR
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City | SAN MARINO
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State | CA
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Zip | 91108-2641
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Country | US
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Telephone | 626-287-9921
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Fax | 626-285-0644
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHIC KAING LIM
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Credential | PHRM D
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Telephone | 626-287-9921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY45238
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License Number State | CA
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