NPIMap

Organization Active NPI

Brookshire Grocery Company

  • Community/Retail Pharmacy
  • Sand Springs, OK
National Provider Identifier
1053671842
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BROOKSHIRE GROCERY COMPANY
Practice address
3825 S Highway 97
Sand Springs, OK 74063-3832
Phone
(918) 246-7202
Fax
(918) 419-2434
NPI assigned
May 25, 2012
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Neil Ducote
Title
VP Pharmacy
Phone
(903) 600-1376

Other NPIs on the same Medicare enrollment 17

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

View all 17

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2270580Reasor'S Pharmacy #9213825 S Highway 97, Sand Springs, OK 74063Certificate of waiverOct 17, 2026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240725004696 OK Part B Supplier - Mass Immunization (Roster Biller Only) 1355415712 17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sand Springs, OK; Sapulpa, OK; Tahlequah, OK; Tulsa, OK; Owasso, OK; Bixby, OK; Broken Arrow, OK; Claremore, OK…

National Provider Directory

National Provider Directory
Tax ID family
Brookshire Grocery Company21 organizations share this tax ID

Corporate family (same tax ID) 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

3925 S State Highway 97
Sand Springs, OK 74063
Phone (918) 246-7202

Specialties & licenses 4

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

NPPES NPI Registry

Primary practice location

3825 S Highway 97
Sand Springs, OK 74063-3832

Mailing address

1600 WSW Loop 323
Tyler, TX 75701-8532

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
2135328OtherPK
100244350MMedicaidOK

Other names 2

NPPES NPI Registry
  • Reasor's Pharmacy #21 Doing business as
  • Reasor's Pharmacy #921 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 30, 2025.

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1053671842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WSW LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 S HIGHWAY 97",
            "city": "SAND SPRINGS",
            "state": "OK",
            "postal_code": "740633832",
            "telephone_number": "918-246-7202",
            "fax_number": "918-419-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-25",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "DUCOTE",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "VP PHARMACY",
        "authorized_official_telephone_number": "903-600-1376"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135328",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244350M",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reasor's Pharmacy #21",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Reasor's Pharmacy #921",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sand Springs, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.