Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Super 1 Pharmacy #645
Organization subpart
No
Provider details
NPI number
Authorized official
TRENT D BROOKSHIRE (EXEC VP-CORPORATE DEVELOPMENT)
(903) 534-3000
Entity
Organization
Contact information
Practice address
1500 BONIN RD, YOUNGSVILLE, LA 70592-5102
(337) 573-6177
(337) 837-5072
Mailing address
1500 BONIN RD, YOUNGSVILLE, LA 70592-5102
(337) 573-6177
(337) 837-5072
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
007545
LA
3336C0003X
Community/Retail Pharmacy
Primary
007545
LA
Other
Enumeration date
11/08/2017
Last updated
11/08/2017
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