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
215 W WILLOW ST, ATTENTION PHARMACY DEPT, LAFAYETTE, LA 70501-2841
(318) 572-9053
(318) 572-9054
Mailing address
215 WEST WILLOW STREET, ATTENTION PHARMACY DEPT, LAFAYETTE, LA 70501
(318) 572-9053
(318) 572-9054
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4111
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1266485
—
LA
01
—
2033926
PK
—
Enumeration date
11/15/2006
Last updated
09/19/2025
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