Provider Demographics
NPI:1386966901
Name:BROUSSARD, NEAL JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:JAMES
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77572-1736
Mailing Address - Country:US
Mailing Address - Phone:281-798-0653
Mailing Address - Fax:
Practice Address - Street 1:800 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-5324
Practice Address - Country:US
Practice Address - Phone:281-471-1241
Practice Address - Fax:281-471-3763
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist