Organization
BROADMOOR DRUG CENTER INC
Active
Other names
BROADMOOR DRUG CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN PELLEGRIN PD (OWNER PHCST)
(985) 876-2584
Entity
Organization
Contact information
Practice address
6096 W PARK AVE, HOUMA, LA 70364-1808
(985) 876-2584
(985) 876-5050
Mailing address
6096 W PARK AVE, HOUMA, LA 70364-1797
(985) 876-2584
(985) 876-5050
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
100IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205745
—
LA
01
—
2028734
PK
—
Enumeration date
11/07/2006
Last updated
09/19/2025
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