Organization
BROOKSHIRE GROCERY COMPANY
Active
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
1800 S HIGH ST, ATTENTION PHARMACY DEPT, LONGVIEW, TX 75602-3210
(903) 234-2785
(903) 234-2789
Mailing address
BROOKSHIRE GROCERY COMPANY, PO BOX 1411, TYLER, TX 75710-1411
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20343
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093497
PK
—
05
—
464505
—
TX
Enumeration date
11/16/2006
Last updated
05/09/2016
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