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Provider Information for 1518030840


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BROOKSHIRE GROCERY COMPANY

Other Names:  
Doing Business As: 
BROOKSHIRES PHARMACY

Organization Subpart: NO

NPI: 1518030840
Last Updated: 2016-08-10
Certification Date:

Details

NameValue
NPI1518030840
Enumeration Date2006-11-16
NPI TypeNPI-2 Organization
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2106653PK
MEDICAIDTX144538
MEDICAIDTX466126
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyTX17514