Healthcare Provider Details

I. General information

NPI: 1053484386
Provider Name (Legal Business Name): BROOKSHIRE GROCERY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PINE ST ATTENTION PHARMACY DEPT
ARKADELPHIA AR
71923-5321
US

IV. Provider business mailing address

2800 PINE STREET NO 5 PINE PLAZA ATTENTION PHARMACY DEPT
ARKADELPHIA AR
71923
US

V. Phone/Fax

Practice location:
  • Phone: 870-246-2015
  • Fax: 870-246-2915
Mailing address:
  • Phone: 870-246-2015
  • Fax: 870-246-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0420003
License Number StateAR

VIII. Authorized Official

Name: JIM COUSINEAU
Title or Position: VP PHARMACY OPERATIONS
Credential: RPH
Phone: 903-877-6514