Active NPI
Felicia Marie Broussard, RPH
- Pharmacist
- Lake Charles, LA
National Provider Identifier
1558795633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 015860
- Practice address
- 600 12TH St
Lake Charles, LA 70601-6128 - Phone
- (337) 436-2508
- NPI assigned
- Aug 26, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 015860 | LA | Primary |
| Pharmacist | 183500000X | 29704 | TX |
Addresses
Primary practice location
600 12TH St
Lake Charles, LA 70601-6128
Mailing address
600 12TH St
Lake Charles, LA 70601-6128
Phone (337) 436-2508
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29704 | TX | MD | General Practice Dentistry |
| 015860 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1558795633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 12TH ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706016128",
"telephone_number": "337-436-2508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 12TH ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706016128",
"telephone_number": "337-436-2508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "FELICIA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-26",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "015860",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "29704",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.