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General NPI Number Information
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NPI Number | 1831725167
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Entity Type | Individual
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Provider Name | JAE LIM
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Gender | Male
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 6005 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-6346
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Country | US
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Telephone | 865-588-5156
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 SAILS WAY
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City | KNOXVILLE
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State | TN
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Zip | 37932-2072
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Country | US
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Telephone | 615-720-2302
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Fax |
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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 | 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 #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 41630
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License Number State | TN
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