Provider Demographics
NPI:1447531926
Name:LIM, SOPHAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:SOPHAN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4553
Mailing Address - Country:US
Mailing Address - Phone:904-771-1987
Mailing Address - Fax:
Practice Address - Street 1:5990 TOWNSEND RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4553
Practice Address - Country:US
Practice Address - Phone:904-771-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist