# BROOKSHIRE GROCERY COMPANY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Super 1 Pharmacy \#639
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780187021
- **Authorized official:** NEIL F DUCOTE (DIRECTOR - PHARMACY OPERATIONS)
- **Authorized official phone:** (903) 534-3478

## Contact information

- **Practice address:** 2004 N PARKERSON AVE, CROWLEY, LA 70526-2336
- **Practice address phone:** (337) 785-2421
- **Practice address fax:** (337) 785-2420
- **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 | 006543 | LA | — |
| 3336C0003X | Community/Retail Pharmacy | 006543 | LA | Yes |

## Other

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