Provider Demographics
NPI:1417231705
Name:BROUSSARD, CYRIL FLOYD
Entity Type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:FLOYD
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14360 WAX RD.
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:LA
Mailing Address - Zip Code:70818
Mailing Address - Country:US
Mailing Address - Phone:225-261-6541
Mailing Address - Fax:225-262-0502
Practice Address - Street 1:14360 WAX RD.
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:LA
Practice Address - Zip Code:70818
Practice Address - Country:US
Practice Address - Phone:225-261-6541
Practice Address - Fax:225-262-0502
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist