NPIMap

Organization Active NPI

Brookshire Grocery Company

Doing business as Super One

  • Community/Retail Pharmacy
  • Carencro, LA
National Provider Identifier
1003182122
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY.006495-RC Issued in LA
Legal business name
BROOKSHIRE GROCERY COMPANY
Doing business as
Super One
Practice address
3916 NE Evangeline Trwy
Carencro, LA 70520-5972
Phone
(337) 886-3660
Fax
(337) 886-3661
NPI assigned
Mar 23, 2012
Last updated
Sep 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jim Cousineau
Title
Sr. VP Pharmacy Ops
Phone
(903) 877-6829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY.006495-RC LA Primary

Addresses

Primary practice location

3916 NE Evangeline Trwy
Carencro, LA 70520-5972

Mailing address

3916 NE Evangeline Thruway
Carencro, LA 70520
Phone (337) 886-3660

Other identifiers 1

IdentifierTypeStateIssuer
2134197OtherPK

Other names 1

  • Super One Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091104000210 LA Part B Supplier - Mass Immunization (Roster Biller Only) 1355415712 38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shreveport, LA; Monroe, LA; Natchitoches, LA; New Iberia, LA; New Roads, LA; Opelousas, LA; Pineville, LA; Ruston, LA…

Other NPIs on the same Medicare enrollment 38

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 38

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1003182122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 NE EVANGELINE THRUWAY",
            "city": "CARENCRO",
            "state": "LA",
            "postal_code": "70520",
            "telephone_number": "337-886-3660",
            "fax_number": "337-886-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3916 NE EVANGELINE TRWY",
            "city": "CARENCRO",
            "state": "LA",
            "postal_code": "705205972",
            "telephone_number": "337-886-3660",
            "fax_number": "337-886-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "COUSINEAU",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "SR. VP PHARMACY OPS",
        "authorized_official_telephone_number": "903-877-6829"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY.006495-RC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134197",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super One",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carencro, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.