Organization
LIMS SHASTA LAKE PHARMACY INC
Active
Other names
LIMS SHASTA LAKE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD LIM PHRMD (PRESIDENT)
(530) 941-1179
Entity
Organization
Contact information
Practice address
4215 FRONT ST, STE 31, SHASTA LAKE, CA 96019-9430
(530) 275-2100
(530) 275-5900
Mailing address
4215 FRONT ST, STE 31, SHASTA LAKE, CA 96019-9430
(530) 275-2100
(530) 275-5900
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY48558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5627748
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/05/2007
Last updated
07/01/2009
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