Organization
BROOKSHIRE GROCERY COMPANY
Active
Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Brookshire Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (V.P. OF PHARMACY OPS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
1200 S 3RD ST, MABANK, TX 75147-7679
(903) 887-6011
(903) 887-6022
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
(903) 887-6011
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28242
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137214
PK
—
Enumeration date
10/19/2012
Last updated
11/22/2016
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