Healthcare Provider Details

I. General information

NPI: 1003145988
Provider Name (Legal Business Name): PAUL OLIVIER BROUSSARD R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 W 8TH ST # 105
HANFORD CA
93230-4533
US

IV. Provider business mailing address

329 W 8TH ST # 105
HANFORD CA
93230-4533
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-4466
  • Fax: 559-924-1001
Mailing address:
  • Phone: 559-582-4466
  • Fax: 559-924-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: