Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Robinson, TX
NPI 1023181591 · NPPES record last updated May 5, 2016
Key facts
- NPI
- 1023181591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 18960 (TX)
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 100 Peplow Dr
Attention Pharmacy Dept
Robinson, TX 76706-5326 - Phone
- (254) 662-6403
- Fax
- (254) 662-6542
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080801000492 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355415712 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
100 Peplow Dr
Robinson, TX 76706
Phone (254) 662-6403
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 18960 | TX | Yes |
Addresses
Primary practice location
100 Peplow Dr
Attention Pharmacy Dept
Robinson, TX 76706-5326
Mailing address
1600 W SW Loop 323
PO Box 1411
Tyler, TX 75701-8532
Phone (903) 877-6827
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2090900 | Other | PK | |
| 464177 | Medicaid | TX |
Other names
- BROOKSHIRES PHARMACY
Other providers in Robinson, TX
- Sofia Bernus
- Sharon Blanchard
- Sherkayla L Bledsoe
- Raven Angel Bright
- Kathryn Elaine Brockington
- Brittani Brown
- Haley Brown
- Jacob Mackenzie Brown
- Cameron J Collier PLLC
- Abigail Marie Carrillo
All providers in Robinson, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.