Organization
BROUSSARDS PHARMACY OF NEW IBERIA INC
Active
Other names
BROUSSARDS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON STELLY RPHRM (OWNER)
(337) 364-2381
Entity
Organization
Contact information
Practice address
600 W SAINT PETER ST, NEW IBERIA, LA 70560-3633
(337) 364-2381
(337) 364-2386
Mailing address
600 W SAINT PETER ST, NEW IBERIA, LA 70560-3633
(337) 364-2381
(337) 364-2386
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY005308-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1271756
—
LA
01
—
1903170
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/03/2006
Last updated
08/31/2011
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