Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
Super 1 Pharmacy #639
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL F DUCOTE (DIRECTOR - PHARMACY OPERATIONS)
(903) 534-3478
Entity
Organization
Contact information
Practice address
2004 N PARKERSON AVE, CROWLEY, LA 70526-2336
(337) 785-2421
(337) 785-2420
Mailing address
1600 WSW LOOP 323, TYLER, TX 75701-8532
(903) 877-6514
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
006543
LA
3336C0003X
Community/Retail Pharmacy
Primary
006543
LA
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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