Provider Demographics
NPI:1447408612
Name:BROUSSARD, KARLA M (RPH)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:M
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PRIDE DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-9526
Mailing Address - Country:US
Mailing Address - Phone:985-543-0092
Mailing Address - Fax:985-543-0603
Practice Address - Street 1:701 PRIDE DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-9526
Practice Address - Country:US
Practice Address - Phone:985-543-0092
Practice Address - Fax:985-543-0603
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist