Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SENIOR VP OF PHRMACY OPS.)
(903) 877-6829
Entity
Organization
Contact information
Practice address
1203 US HIGHWAY 380, BRIDGEPORT, TX 76426-2087
(940) 683-1510
(940) 683-1515
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
(903) 877-6862
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
27158
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5901500
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/26/2010
Last updated
11/01/2012
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