Active NPI
Brookshire Grocery Company
- Community/Retail Pharmacy
- Crossett, AR
National Provider Identifier
1063585537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 0418120
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 1600 Dr Martin Luther King Jr Dr
Attention Pharmacy Dept
Crossett, AR 71635-3363 - Phone
- (870) 364-8220
- Fax
- (870) 364-8220
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0418120 | AR | Primary |
Addresses
Primary practice location
1600 Dr Martin Luther King Jr Dr
Attention Pharmacy Dept
Crossett, AR 71635-3363
Mailing address
1600 Dr Martin Luther King Jr Dr
Attention Pharmacy Dept
Crossett, AR 71635-3363
Phone (870) 364-8220
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123907407 | Medicaid | AR | |
| 1995381 | Other | PK |
Other names 1
- BROOKSHIRES PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091023000007 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355415712 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ashdown, AR; Arkadelphia, AR; Pine Bluff, AR; Maganolia, AR; El Dorado, AR; Crossett, AR; Camden, AR; Hope, AR |
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1447804800000",
"number": "1063585537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 DR MARTIN LUTHER KING JR DR",
"address_2": "ATTENTION PHARMACY DEPT",
"city": "CROSSETT",
"state": "AR",
"postal_code": "716353363",
"telephone_number": "870-364-8220",
"fax_number": "870-364-8220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 DR MARTIN LUTHER KING JR DR",
"address_2": "ATTENTION PHARMACY DEPT",
"city": "CROSSETT",
"state": "AR",
"postal_code": "716353363",
"telephone_number": "870-364-8220",
"fax_number": "870-364-8220"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOKSHIRE GROCERY COMPANY",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2015-11-18",
"status": "A",
"authorized_official_last_name": "COUSINEAU",
"authorized_official_first_name": "JIM",
"authorized_official_title_or_position": "VP PHARMACY OPERATIONS",
"authorized_official_telephone_number": "903-877-6514",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "AR",
"license": "0418120",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123907407",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "1995381",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "BROOKSHIRES PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Crossett, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.