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
1600 DR MARTIN LUTHER KING JR DR, ATTENTION PHARMACY DEPT, CROSSETT, AR 71635-3363
(870) 364-8220
(870) 364-8220
Mailing address
1600 DR MARTIN LUTHER KING JR DR, ATTENTION PHARMACY DEPT, CROSSETT, AR 71635-3363
(870) 364-8220
(870) 364-8220
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0418120
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123907407
—
AR
01
—
1995381
PK
—
Enumeration date
11/15/2006
Last updated
11/18/2015
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