Individual
BRIA BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 HIGHWAY 80 E, CLINTON, MS 39056-4738
(601) 925-6343
Mailing address
2604 COLONY PARK DR, PEARL, MS 39208-6375
(504) 338-3826
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-16213
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1279206
NABP
MS
Enumeration date
11/16/2020
Last updated
11/16/2020
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