Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Haughton, LA
NPI 1043383516 · NPPES record last updated Dec 22, 2015
Key facts
- NPI
- 1043383516
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 3290 (LA)
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 1125 Highway 80
Attention Pharmacy Dept
Haughton, LA 71037-9430 - Phone
- (318) 949-8476
- Fax
- (318) 949-4325
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
Other NPIs on the same Medicare enrollment 38
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 3290 | LA | Yes |
Addresses
Primary practice location
1125 Highway 80
Attention Pharmacy Dept
Haughton, LA 71037-9430
Mailing address
1600 W SW Loop 323
PO Box 1411
Tyler, TX 75701-8532
Phone (903) 877-6827
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1263249 | Medicaid | LA | |
| 2033526 | Other | PK |
Other names
- BROOKSHIRES PHARMACY
Other providers in Haughton, LA
- Bayou Sports Medicine LLC
- Alan Brent Berry
- Jenna Bison
- Ashley Bradford
- Brittany G House a Professional Corporation
- Hunter Brown
- Jo Linn Burt
- Carol Hacker Cameron
- Kayla Cayer
- Coleman Medical Group Apmc
All providers in Haughton, LA · Community/Retail Pharmacy in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2015. 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.