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
404 W CENTRAL AVE, ATTENTION PHARMACY DEPT, COMANCHE, TX 76442-2706
(325) 356-5276
(325) 356-3259
Mailing address
BROOKSHIRE GROCERY CO, PO BOX 1411, TYLER, TX 75701-1411
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19052
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2091021
PK
—
05
—
464195
—
TX
Enumeration date
11/16/2006
Last updated
06/03/2016
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