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
502C EAST GOODE, ATTENTION PHARMACY DEPT, QUITMAN, TX 75783
(903) 763-1420
(903) 763-3360
Mailing address
BROOKSHIRE GROCERY CO, PO BOX 934, TYLER, TX 75710
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21430
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2097329
PK
—
05
—
465214
—
TX
Enumeration date
11/16/2006
Last updated
12/22/2015
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