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NPI Code Detail

MEDICARE: BROOKSHIRES GROCERY COMPANY

MEDICARE: BROOKSHIRES 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
1183500000XPharmacist019518LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11628OTHERLAMEDICATION ADMINISTRATION NUMBER

General Provider Information

NPI Number : 1538441381
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKSHIRES GROCERY COMPANY
Provider Business Mailing Address
First Line : 388 BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-8123
Country : US
Telephone Number : 318-687-7558
Fax Number :
Provider Business Practice Location Address
First Line : 388 BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-8123
Country : US
Telephone Number : 318-687-7558
Fax Number :
Authorized Official
Title or Position : PHARMACIST
Name : MISS ASHLEY NICOLE SLOCUM
Credential : PHARM.D.
Telephone Number : 318-687-7558
Provider Enumeration Date : 09/16/2011
Last Update Date : 10/14/2011

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Directions to “BROOKSHIRES GROCERY COMPANY ” Practice Location

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