Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Super 1 Pharmacy #643
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU (SR. VP OF PHARMACY OPERATIONS)
(903) 877-6829
Entity
Organization
Contact information
Practice address
200 DESTINATION POINTE LN., SCOTT, LA 70583
(337) 210-2001
(337) 236-6531
Mailing address
200 DESTINATION POINTE LN., SCOTT, LA 70583
(337) 210-2001
(337) 236-6531
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
007485
LA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169752
PK
—
Enumeration date
06/18/2017
Last updated
06/18/2017
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