Lims Shasta Lake Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY48558 Issued in CA

Legal business name

LIMS SHASTA LAKE PHARMACY INC

Practice address

4215 Front St
Ste 31
Shasta Lake, CA 96019-9430

Phone

(530) 275-2100

Fax

(530) 275-5900

NPI assigned

Aug 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald Lim, PHRMD

Title

President

Phone

(530) 941-1179

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LIMS SHASTA LAKE PHARMACY INC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246406400000",
    "number": "1154512226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 FRONT ST",
            "address_2": "STE 31",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199430",
            "telephone_number": "530-275-2100",
            "fax_number": "530-275-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 FRONT ST",
            "address_2": "STE 31",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199430",
            "telephone_number": "530-275-2100",
            "fax_number": "530-275-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIMS SHASTA LAKE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2009-07-01",
        "status": "A",
        "authorized_official_last_name": "LIM",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-941-1179",
        "authorized_official_credential": "PHRMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY48558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5627748",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIMS SHASTA LAKE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Lewis Kobe, D.C.
• Kay Ellen Kobe, D.C.
• Marion Ann Rose Kvasnicka, LCSW
• Heather Land
• Kathleen Lemos, OTR/L
• Jill M Marshall, LCSW
• Richard Arthur Martin, O.D.
• John Meyer, PHARMD
• Tina Marie Milan, LCSW
• Kathryn Jocelyn Nuss, CASII, NCACI

• Community/Retail Pharmacy in Shasta Lake, CA
• Providers in Shasta Lake, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.