Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU RPH (VP OF PHCY OPER)
(903) 877-6829
Entity
Organization
Contact information
Practice address
1325 W WHITE ST, ANNA, TX 75409-5007
(972) 924-4220
(972) 924-4773
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
(903) 877-6514
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
25923
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4548333
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/02/2008
Last updated
11/01/2012
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