MEDICARE: DR. BOB JOHN MATRIANO-LIM PHARM.D.

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	183500000X	Pharmacist	017233	LA

General Provider Information

NPI Number	:	1417247438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOB JOHN MATRIANO-LIM PHARM.D.

Provider Business Mailing Address
First Line	:	204 SILVER FOX CIR
Second Line	:
City	:	HAUGHTON
State	:	LA
Zip	:	71037-7704
Country	:	US
Telephone Number	:	318-564-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 N MARKET ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-5212
Country	:	US
Telephone Number	:	318-222-2972
Fax Number	:	318-222-1889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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