Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRES PHARMACY #49
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
1001 E MILAM ST, ATTENTION PHARMACY DEPT, MEXIA, TX 76667-2528
(254) 562-9331
(817) 562-9332
Mailing address
PO BOX 1411, ATTENTION PHARMACY DEPT, TYLER, TX 75710-1411
(254) 562-9331
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
15944
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548333016
NPI
—
01
—
15944
TX STATE BOARD OF PHARMACY LICENSE
TX
01
—
4591548
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
463953
—
TX
01
—
B0088527
TX DPS
TX
01
—
DME00T076
TMHP MEDICARE CROSSOVER TO TX MEDICAID
TX
01
—
PH0342
MEDICARE IMMUNIZATION BILLING--TRAILBLAZER
TX
Enumeration date
11/15/2006
Last updated
03/07/2023
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