Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Brookshire Pharmacy #88
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SR VP PHARMACY OPS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
2300 W ENNIS AVE, ENNIS, TX 75119-8039
(972) 875-4607
(972) 875-2060
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
(903) 877-6827
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28377
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139824
PK
—
Enumeration date
04/15/2013
Last updated
07/30/2013
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