Active NPI
Eva Broussard
- Pharmacist
- Lake Charles, LA
National Provider Identifier
1619561008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.011753
- Practice address
- 260 Sam Houston Jones Pkwy
Lake Charles, LA 70611-5603 - Phone
- (337) 214-6402
- NPI assigned
- Feb 25, 2021
- Sex
- Female
- 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 | PST.011753 | LA | Primary |
Addresses
Primary practice location
260 Sam Houston Jones Pkwy
Lake Charles, LA 70611-5603
Mailing address
1776 Crawford Dr
Lake Charles, LA 70611-4661
Phone (337) 515-6579
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 |
|---|---|---|---|
| PST.011753 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614211200000",
"number": "1619561008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 CRAWFORD DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706114661",
"telephone_number": "337-515-6579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 SAM HOUSTON JONES PKWY",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706115603",
"telephone_number": "337-214-6402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "EVA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-25",
"last_updated": "2021-02-25",
"certification_date": "2021-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.011753",
"primary": true
}
],
"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 Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.