Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRES 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
2107 S LOOP 256, ATTENTION PHARMACY DEPT, PALESTINE, TX 75801-5919
(903) 723-1092
(903) 729-2652
Mailing address
1600 W SW LOOP 323, PO BOX 1411, TYLER, TX 75701-8532
(903) 877-6827
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
23995
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2096858
PK
—
05
—
466151
—
TX
Enumeration date
11/15/2006
Last updated
08/18/2016
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