# BROOKSHIRE GROCERY COMPANY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Super 1 Pharmacy \#646
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114420452
- **Authorized official:** NEIL F DUCOTE (DIRECTOR - PHARMACY OPERATIONS)
- **Authorized official phone:** (903) 534-3478

## Contact information

- **Practice address:** 924 REES ST, BREAUX BRIDGE, LA 70517-4514
- **Practice address phone:** (337) 332-6339
- **Practice address fax:** (337) 332-5884
- **Mailing address:** 1600 WSW LOOP 323, TYLER, TX 75701-8532
- **Mailing address phone:** (903) 877-6514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 06562 | LA | — |
| 3336C0003X | Community/Retail Pharmacy | 006562 | LA | Yes |

## Other

- **Enumeration date:** 03/13/2018
- **Last updated:** 03/13/2018