Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Super One
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SR. VP PHARMACY OPS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
3916 NE EVANGELINE TRWY, CARENCRO, LA 70520-5972
(337) 886-3660
(337) 886-3661
Mailing address
3916 NE EVANGELINE THRUWAY, CARENCRO, LA 70520
(337) 886-3660
(337) 886-3661
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006495-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134197
PK
—
Enumeration date
03/23/2012
Last updated
09/19/2025
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