Organization
BROOKSHIRE GROCERY COMPANY
Active
Other names
SUPER 1 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
4811 WESLEY ST, ATTENTION PHARMACY DEPT, GREENVILLE, TX 75401-5649
(903) 454-8701
(903) 454-6089
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
16080
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2104414
PK
—
05
—
463968
—
TX
Enumeration date
11/15/2006
Last updated
06/23/2016
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