Provider Demographics
NPI:1376206284
Name:BROUSSARD, JORHN ALNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORHN
Middle Name:ALNE
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 VILLAGE POND LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8781
Mailing Address - Country:US
Mailing Address - Phone:281-896-2448
Mailing Address - Fax:
Practice Address - Street 1:15027 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3262
Practice Address - Country:US
Practice Address - Phone:281-431-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist