MEDICARE: P.S. ENTERPRISE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PHY45238	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0524846	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669569810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.S. ENTERPRISE, INC

Provider Business Mailing Address
First Line	:	2300 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2641
Country	:	US
Telephone Number	:	626-287-9921
Fax Number	:	626-285-0644

Provider Business Practice Location Address
First Line	:	2300 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2641
Country	:	US
Telephone Number	:	626-287-9921
Fax Number	:	626-285-0644

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHIC KAING LIM
Credential	:	PHRM D
Telephone Number	:	626-287-9921

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	03/30/2011

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Directions to “P.S. ENTERPRISE, INC ” Practice Location

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