Basic Information
| Provider Information | |||||||||
| NPI: | 1003145988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROUSSARD | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | OLIVIER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 W HANFORD ARMONA RD | ||||||||
| Address2: | |||||||||
| City: | LEMOORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599246495 | ||||||||
| FaxNumber: | 5599240644 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 W HANFORD ARMONA RD | ||||||||
| Address2: | |||||||||
| City: | LEMOORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932452302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599246495 | ||||||||
| FaxNumber: | 5599240644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 43332 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.