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General NPI Number Information
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NPI Number | 1962449629
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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 | 06/01/2006
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2429 E 15TH ST
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City | TULSA
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State | OK
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Zip | 74104-4618
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Country | US
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Telephone | 918-748-8350
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Fax | 918-747-1974
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Provider Business Mailing Address
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Address Line | 1600 WSW LOOP 323
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City | TYLER
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State | TX
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Zip | 75701-8532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP PHARMACY
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Name | NEIL DUCOTE
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Credential |
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Telephone | 903-600-1376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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