Organization
BROOKSHIRE GROCERY COMPANY
Active
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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