Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRES PHARMACY #33
Organization subpart
No
Provider details
NPI number
Authorized official
JIM D COUSINEAU RPH (VP PHARMACY OPERATIONS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
205 W FRANK ST, ATTENTION PHARMACY DEPT, GRAND SALINE, TX 75140-1757
(903) 962-4063
(903) 962-4253
Mailing address
PO BOX 1411, ATTN PHCY DEPT, TYLER, TX 75710-1411
(903) 962-4063
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25127
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285707752
NPI
—
05
—
145708
—
TX
01
—
25127
TX STATE BOARD OF PHARMACY LICENSE
TX
01
—
4542608
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
PH0342
MEDICARE IMMUNIZATION BILLING--TRAILBLAZER
TX
01
—
R0148456
TX DPS
TX
Enumeration date
11/15/2006
Last updated
03/07/2023
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