Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
SUPER 1 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
1105 E GENTRY PKWY, ATTENTION PHARMACY DEPT, TYLER, TX 75702-4715
(903) 535-9467
(903) 535-9468
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16238
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2104432
PK
—
05
—
463965
—
TX
Enumeration date
11/16/2006
Last updated
11/22/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us