Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Brookshire Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SR VP PHARMACY OPS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
6991 OLD JACKSONVILLE HWY, TYLER, TX 75703-0579
(903) 747-3508
(903) 747-3514
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
(903) 877-6827
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27106
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5902425
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/08/2011
Last updated
11/19/2012
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