Provider Information for 1518030840
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BROOKSHIRE GROCERY COMPANY
Other Names:Doing Business As:BROOKSHIRES PHARMACYOrganization Subpart: NO
NPI: 1518030840
Last Updated: 2016-08-10
Certification Date:
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Details
| Name | Value | ||||||||||||||||
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| NPI | 1518030840 | ||||||||||||||||
| Enumeration Date | 2006-11-16 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: JIM COUSINEAU RPH Title: VP PHARMACY OPERATIONS Phone: 9038776514 | ||||||||||||||||
| Mailing Address | PO BOX 1409 CHANDLER, TX 75758-1409 United States Phone: | Fax: | ||||||||||||||||
| Primary Practice Address | 703 HWY 31 EAST ATTENTION PHARMACY DEPT CHANDLER, TX 75758 United States Phone: 903-849-4090 | Fax:903-849-4129 | ||||||||||||||||
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