Healthcare Provider Details

I. General information

NPI: 1992710529
Provider Name (Legal Business Name): THE COMPOUNDING PHARMACY OF SCOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 CAMERON ST STE 100A
SCOTT LA
70583
US

IV. Provider business mailing address

PO BOX 809
SCOTT LA
70583-0809
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-2003
  • Fax: 337-233-3385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5633IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD CHRISTOPHER BROUSSARD
Title or Position: OWNER
Credential:
Phone: 337-233-3382