Individual
JACOB STEVEN BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2204 S 5TH ST, LEESVILLE, LA 71446-5318
(337) 238-9041
Mailing address
212 N FERNAND ST, DELCAMBRE, LA 70528-3004
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
022088
LA
Other
Enumeration date
03/19/2018
Last updated
03/19/2018
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