Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Brookshire Pharmacy #034
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SR. VP PHARMACY OPS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
1801 N 18TH ST, MONROE, LA 71201-4401
(318) 340-6470
(318) 340-6473
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
(903) 877-6863
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
007138
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152893
PK
—
Enumeration date
07/02/2015
Last updated
07/22/2015
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