Provider Demographics
NPI:1518267277
Name:BROUSSARD, CHAD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
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 1:5900 CAMERON ST
Mailing Address - Street 2:P.O. BOX 809
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5182
Mailing Address - Country:US
Mailing Address - Phone:337-233-3382
Mailing Address - Fax:337-233-3385
Practice Address - Street 1:5900 CAMERON ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5182
Practice Address - Country:US
Practice Address - Phone:337-233-3382
Practice Address - Fax:337-233-3385
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist