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NPI Code Detail

MEDICARE: BROOKSHIRE GROCERY COMPANY

MEDICARE: BROOKSHIRE GROCERY COMPANY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy21346TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12096740OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013080589
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKSHIRE GROCERY COMPANY
Provider Business Mailing Address
First Line : PO BOX 1411
Second Line :
City : TYLER
State : TX
Zip : 75710-1411
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1310 N BRAZOS ST
Second Line : ATTENTION PHARMACY DEPT
City : WHITNEY
State : TX
Zip : 76692-2010
Country : US
Telephone Number : 254-694-4413
Fax Number : 254-694-4418
Authorized Official
Title or Position : VP PHARMACY OPERATIONS
Name : JIM COUSINEAU
Credential : RPH
Telephone Number : 903-877-6514
Provider Enumeration Date : 11/15/2006
Last Update Date : 11/18/2015

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Directions to “BROOKSHIRE GROCERY COMPANY ” Practice Location

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