Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Brookshire Pharmacy #029
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SR. VP PHARMACY OPS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
318 DIXIE PLZ, NATCHITOCHES, LA 71457-5880
(318) 352-3141
Mailing address
318 DIXIE PLZ, NATCHITOCHES, LA 71457-5880
(318) 352-3141
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY007217RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155492
PK
—
Enumeration date
11/24/2015
Last updated
12/10/2015
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