Active NPI
Wilfred Broussard Jr.
- Pharmacist
- Plano, TX
National Provider Identifier
1104077890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19241
- Practice address
- 801 Legacy Dr Apt 2311
Plano, TX 75023-2228 - Phone
- (469) 241-1866
- NPI assigned
- Oct 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19241 | TX | Primary |
Addresses
Primary practice location
801 Legacy Dr Apt 2311
Plano, TX 75023-2228
Mailing address
801 Legacy Dr Apt 2311
Plano, TX 75023-2228
Phone (469) 241-1866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19241 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222819200000",
"number": "1104077890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 LEGACY DR APT 2311",
"city": "PLANO",
"state": "TX",
"postal_code": "750232228",
"telephone_number": "469-241-1866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 LEGACY DR APT 2311",
"city": "PLANO",
"state": "TX",
"postal_code": "750232228",
"telephone_number": "469-241-1866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "WILFRED",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-01",
"last_updated": "2008-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "19241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.