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Organization
BROOKSHIRE GROCERY COMPANY
Active
Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU RPH (VP PHARMACY OPERATIONS)
(903) 877-6514
Entity
Organization
Contact information
Practice address
510 KINGS HWY, ATTENTION PHARMACY DEPT, SHREVEPORT, LA 71104-4444
(318) 424-0896
(318) 424-0898
Mailing address
1600 W SW LOOP 323, PO BOX 1411, TYLER, TX 75701-8532
(903) 877-6827
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
3297
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1263265
—
LA
01
—
2033529
PK
—
Enumeration date
11/15/2006
Last updated
12/22/2015
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