NPIMap

Organization Active NPI

Brookshire Grocery Company

  • Community/Retail Pharmacy
  • Broken Arrow, OK
National Provider Identifier
1063252260
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BROOKSHIRE GROCERY COMPANY
Practice address
1914 W. Norfolk Drive
Broken Arrow, OK 74011
Phone
(539) 250-4625
Fax
(539) 250-4693
NPI assigned
May 28, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Authorized official

Name
Ronald Michael Arnett
Title
Evp-Cfo
Phone
(903) 534-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1914 W. Norfolk Drive
Broken Arrow, OK 74011

Mailing address

1600 SSW Loop 323
Tyler, TX 75701
Phone (903) 534-3000

Other names 1

  • Reasor's Pharmacy #905 Doing business as

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…

Other NPIs on the same Medicare enrollment 17

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

View all 17

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
37D2310519Reasor'S Pharmacy #9051914 W Norfolk Dr, Broken Arrow, OK 74011Certificate of waiverSep 4, 2026

National Provider Directory

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

Other organizations with this tax ID 20

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

View all 20

Locations

1914 W Norfolk Dr
Broken Arrow, OK 74011
Phone (539) 250-4625

NPI Registry JSON

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

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1063252260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SSW LOOP 323",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-534-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 W. NORFOLK DRIVE",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74011",
            "telephone_number": "539-250-4625",
            "fax_number": "539-250-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-28",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "ARNETT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "EVP-CFO",
        "authorized_official_telephone_number": "903-534-3000"
    },
    "taxonomies": [
        {
            "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reasor's Pharmacy #905",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Reasor's Pharmacy #905",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.