Cyril Floyd Broussard
Individual provider Active NPI Pharmacist · Central, LA
NPI 1417231705 · NPPES record last updated Oct 5, 2011
Key facts
- NPI
- 1417231705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 13187 (LA)
- Practice address
- 14360 Wax Rd.
Central, LA 70818 - Phone
- (225) 261-6541
- Fax
- (225) 262-0502
- NPI assigned
- Oct 5, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13187 | LA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13187 | LA | Yes |
Addresses
Primary practice location
14360 Wax Rd.
Central, LA 70818
Mailing address
14360 Wax Rd.
Central, LA 70818
Phone (225) 261-6541
Other providers in Central, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.