Healthcare Provider Details

I. General information

NPI: 1326111899
Provider Name (Legal Business Name): BROOKSHIRE GROCERY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 DOLLARWAY RD ATTENTION PHARMACY DEPT
PINE BLUFF AR
71602-3824
US

IV. Provider business mailing address

5805 DOLLARWAY ROAD ATTENTION PHARMACY DEPT
PINE BLUFF AR
71602
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-5854
  • Fax: 870-247-1782
Mailing address:
  • Phone: 870-247-5854
  • Fax: 870-247-1782

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 Number0420005
License Number StateAR

VIII. Authorized Official

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