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General NPI Number Information
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NPI Number | 1538441381
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Entity Type | Organization
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Legal Business Name | BROOKSHIRES GROCERY COMPANY
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 388 BERT KOUNS LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71106-8123
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Country | US
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Telephone | 318-687-7558
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Fax |
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Provider Business Mailing Address
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Address Line | 388 BERT KOUNS LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71106-8123
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Country | US
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Telephone | 318-687-7558
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MISS ASHLEY NICOLE SLOCUM
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Credential | PHARM.D.
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Telephone | 318-687-7558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 019518
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License Number State | LA
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