Active NPI
David L Broussard, R.PH.
- Pharmacist
- Lafayette, LA
National Provider Identifier
1720360647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16011
- Practice address
- 4406 Johnston St
Lafayette, LA 70503-4234 - Phone
- (337) 984-5220
- Fax
- (337) 984-0493
- NPI assigned
- Sep 16, 2011
- Last updated
- Sep 16, 2011
- 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 | 16011 | LA | Primary |
Addresses
Primary practice location
4406 Johnston St
Lafayette, LA 70503-4234
Mailing address
4406 Johnston St
Lafayette, LA 70503-4234
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 |
|---|---|---|---|
| 16011 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316131200000",
"number": "1720360647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4406 JOHNSTON ST",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705034234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4406 JOHNSTON ST",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705034234",
"telephone_number": "337-984-5220",
"fax_number": "337-984-0493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "DAVID",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-16",
"last_updated": "2011-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "16011",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.