Healthcare Provider Details

I. General information

NPI: 1679429468
Provider Name (Legal Business Name): LYNETTE MARIA BROUSSARD-WALKER R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 FAIRWAY BLVD
VIEW PARK CA
90043-1111
US

IV. Provider business mailing address

3620 FAIRWAY BLVD
VIEW PARK CA
90043-1111
US

V. Phone/Fax

Practice location:
  • Phone: 310-613-7533
  • Fax:
Mailing address:
  • Phone: 310-613-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: