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General NPI Number Information
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NPI Number | 1710314844
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Entity Type | Individual
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Provider Name | MARY LIM
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 17901 HWY 213
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City | OREGON CITY
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State | OR
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Zip | 97045-0000
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Country | US
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Telephone | 503-451-7961
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Fax | 503-451-7995
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Provider Business Mailing Address
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Address Line | 17901 HWY 213
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City | OREGON CITY
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State | OR
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Zip | 97045-0000
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Country | US
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Telephone | 503-451-7961
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Fax | 503-451-7995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8986
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License Number State | OR
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