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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