Provider Demographics
NPI:1003145988
Name:BROUSSARD, PAUL OLIVIER (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:OLIVIER
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W HANFORD ARMONA RD
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245
Mailing Address - Country:US
Mailing Address - Phone:559-924-6495
Mailing Address - Fax:559-924-0644
Practice Address - Street 1:209 C ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2930
Practice Address - Country:US
Practice Address - Phone:559-925-8600
Practice Address - Fax:559-924-1001
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist