Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRES PHARMACY #121
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
5841 RIDGEWOOD RD, ATTENTION PHARMACY DEPT, JACKSON, MS 39211-2618
(601) 978-1747
(601) 978-3150
Mailing address
PO BOX 1411, ATTENTION PHARMACY DEPT, TYLER, TX 75710-1411
(601) 978-1747
(903) 877-6909
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
05104 / 01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330682
—
MS
01
—
2521107
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/15/2006
Last updated
02/27/2008
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