Individual
MR. JOHN EDWARD BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
105 CITIES SERVICE HWY, SULPHUR, LA 70663-5419
(337) 533-1137
(337) 533-9879
Mailing address
105 CITIES SERVICE HWY, SULPHUR, LA 70663-5419
(337) 533-1137
(337) 533-9879
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13303
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-331
LOUISANA BOARD OF PHARMACY MEDICATION ADMINISTRATIONJ REGISTRY NUMBER
LA
05
—
1896195
—
LA
Enumeration date
08/16/2010
Last updated
08/16/2010
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