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General NPI Number Information
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NPI Number | 1003182122
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Entity Type | Organization
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Legal Business Name | BROOKSHIRE GROCERY COMPANY
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3916 NE EVANGELINE TRWY
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City | CARENCRO
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State | LA
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Zip | 70520-5972
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Country | US
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Telephone | 337-886-3660
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Fax | 337-886-3661
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Provider Business Mailing Address
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Address Line | 3916 NE EVANGELINE THRUWAY
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City | CARENCRO
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State | LA
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Zip | 70520
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Country | US
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Telephone | 337-886-3660
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Fax | 337-886-3661
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Authorized Official
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Title or Position | SR. VP PHARMACY OPS
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Name | JIM COUSINEAU
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Credential |
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Telephone | 903-877-6829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY.006495-RC
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License Number State | LA
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