Active NPI
Malcolm J Broussard
- Pharmacist
- Baton Rouge, LA
National Provider Identifier
1346241007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11396
- Practice address
- 3388 Brentwood Dr
Baton Rouge, LA 70809-1700 - Phone
- (225) 925-6481
- Fax
- (225) 922-0316
- NPI assigned
- Aug 3, 2005
- 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 | 11396 | LA | Primary |
Addresses
Primary practice location
3388 Brentwood Dr
Baton Rouge, LA 70809-1700
Mailing address
3388 Brentwood Dr
Baton Rouge, LA 70809-1700
Phone (225) 925-6481
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 |
|---|---|---|---|
| 11396 | LA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302134400000",
"number": "1346241007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3388 BRENTWOOD DR",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708091700",
"telephone_number": "225-925-6481",
"fax_number": "225-922-0316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3388 BRENTWOOD DR",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708091700",
"telephone_number": "225-925-6481",
"fax_number": "225-922-0316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "MALCOLM",
"middle_name": "J",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2011-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "11396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.