Healthcare Provider Details

I. General information

NPI: 1316895816
Provider Name (Legal Business Name): SCOTTY PAUL BROUSSARD PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S KIBBE ST
ERATH LA
70533-3917
US

IV. Provider business mailing address

605 S KIBBE ST
ERATH LA
70533-3917
US

V. Phone/Fax

Practice location:
  • Phone: 337-453-7328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.015681
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: