Organization
BROOKSHIRE GROCERY COMPANY
Active
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
1623 E MAIN ST, ATTENTION PHARMACY DEPT, MAGNOLIA, AR 71753-3803
(870) 234-7073
(870) 234-7169
Mailing address
1600 W SW LOOP 323, PO BOX 1411, TYLER, TX 75701-8532
(903) 877-6827
(903) 877-3820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0418221
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123906407
—
AR
01
—
1995390
PK
—
Enumeration date
11/15/2006
Last updated
11/18/2015
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