Active NPI
Richard Wayne Broussard
- Pharmacist
- Dayton, TX
National Provider Identifier
1386460004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22117
- Practice address
- 403 E Highway 90
Dayton, TX 77535-2629 - Phone
- (936) 258-2166
- Fax
- (936) 258-7617
- NPI assigned
- Nov 26, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 22117 | TX | Primary |
Addresses
Primary practice location
403 E Highway 90
Dayton, TX 77535-2629
Mailing address
403 E Highway 90
Dayton, TX 77535-2629
Phone (936) 258-2166
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 |
|---|---|---|---|
| 22117 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brookshire Brothers Inc | Past | Accepting new patients | |
| Brookshire Brothers Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Jarrell, TX
- NPI 1396615183
-
- Community/Retail Pharmacy
- Dayton, TX
- NPI 1396844619
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732579200000",
"number": "1386460004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 E HIGHWAY 90",
"city": "DAYTON",
"state": "TX",
"postal_code": "775352629",
"telephone_number": "936-258-2166",
"fax_number": "936-258-2166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 E HIGHWAY 90",
"city": "DAYTON",
"state": "TX",
"postal_code": "775352629",
"telephone_number": "936-258-2166",
"fax_number": "936-258-7617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "RICHARD",
"middle_name": "WAYNE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-11-26",
"last_updated": "2024-11-26",
"certification_date": "2024-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "22117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.