Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
SUPER 1 PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU RPH (VP PHARMACY OPERATIONS)
(903) 877-6514
Entity
Organization
Contact information
Practice address
602 JEFFERSON PARK, ATTENTION PHARMACY DEPT, MT PLEASANT, TX 75455
(903) 575-1610
(903) 575-1607
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095835
PK
—
05
—
464887
—
TX
Enumeration date
11/15/2006
Last updated
08/10/2016
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