Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
BROOKSHIRES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIM COUSINEAU RPH (VP PHARMACY OPERATIONS)
(903) 877-6514
Entity
Organization
Contact information
Practice address
5696 HIGHWAY 1 BYP, ATTENTION PHARMACY DEPT, NATCHITOCHES, LA 71457-3254
(318) 214-0048
(318) 240-0790
Mailing address
PO BOX 1411, TYLER, TX 75710-1411
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.004728-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1269166
—
LA
01
—
2035051
PK
—
Enumeration date
11/15/2006
Last updated
12/22/2015
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