Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Super 1 Pharmacy #646
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL F DUCOTE (DIRECTOR - PHARMACY OPERATIONS)
(903) 534-3478
Entity
Organization
Contact information
Practice address
924 REES ST, BREAUX BRIDGE, LA 70517-4514
(337) 332-6339
(337) 332-5884
Mailing address
1600 WSW LOOP 323, TYLER, TX 75701-8532
(903) 877-6514
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
06562
LA
3336C0003X
Community/Retail Pharmacy
Primary
006562
LA
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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