Provider Demographics
NPI:1336593334
Name:BROUSSEAU, KAREN A (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:BROUSSEAU
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 1:3499 INDIAN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4949
Mailing Address - Country:US
Mailing Address - Phone:805-241-9712
Mailing Address - Fax:
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:STE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-495-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist