# BROOKSHIRE GROCERY COMPANY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BROOKSHIRES PHARMACY \#120
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588737050
- **Authorized official:** JIM D COUSINEAU RPH (VP PHARMACY OPERATIONS)
- **Authorized official phone:** (903) 877-6829

## Contact information

- **Practice address:** 7045 OLD CANTON RD, ATTENTION PHARMACY DEPT, RIDGELAND, MS 39157-1036
- **Practice address phone:** (601) 856-0977
- **Practice address fax:** (601) 856-1492
- **Mailing address:** PO BOX 1411, ATTENTION PHARMACY DEPT, TYLER, TX 75710-1411
- **Mailing address phone:** (601) 856-0977
- **Mailing address fax:** (903) 877-6909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | 03594 / 01.2 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 02/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0330685 | — | MS |
| 01 | — | 2521094 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |