Healthcare Provider Details

I. General information

NPI: 1407809692
Provider Name (Legal Business Name): JUDE JOHN BROUSSARD PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ST LANDRY ST
LAFAYETTE LA
70506
US

IV. Provider business mailing address

8924 RIVER ROAD
ABBERVILLE LA
70510
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-2755
  • Fax: 337-289-2578
Mailing address:
  • Phone: 337-893-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14224
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: