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Organization

BROOKSHIRE GROCERY COMPANY

Active
Other names
BROOKSHIRE PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
JIM COUSINEAU (VP PHRM OPER)
(903) 877-6829
Entity
Organization

Contact information

Practice address
1105 W SOUTH COMMERCE ST, WILLS POINT, TX 75169-2355
(903) 873-8237
(903) 873-8732
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
25507
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4544602
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
04/24/2007
Last updated
11/01/2012
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