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
706 WEST MAIN, ATTENTION PHARMACY DEPT, VAN, TX 75790
(903) 963-3834
(903) 963-3534
Mailing address
PO BOX 1219, ATTENTION PHARMACY DEPT, VAN, TX 75790-1219
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095837
PK
—
05
—
464885
—
TX
Enumeration date
11/16/2006
Last updated
08/19/2016
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