NPIMap

Organization Active NPI

Brookshire Grocery Company

Doing business as Super 1 Pharmacy #637

  • Community/Retail Pharmacy
  • Eunice, LA
National Provider Identifier
1083117303
Registry record updated Mar 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
006545 Issued in LA
Legal business name
BROOKSHIRE GROCERY COMPANY
Doing business as
Super 1 Pharmacy #637
Practice address
1800 W Laurel Ave
Eunice, LA 70535-2902
Phone
(337) 457-4827
Fax
(337) 457-4223
NPI assigned
Mar 13, 2018
Last updated
Mar 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2018

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

Authorized official

Name
Neil F Ducote
Title
Director - Pharmacy Operations
Phone
(903) 534-3478

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 006545 LA
Community/Retail Pharmacy 3336C0003X 006545 LA Primary

Addresses

Primary practice location

1800 W Laurel Ave
Eunice, LA 70535-2902

Mailing address

1600 WSW Loop 323
Tyler, TX 75701-8532
Phone (903) 877-6514

Other names 1

  • Super 1 Pharmacy #637 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 38

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

View all 38

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1083117303",
    "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",
            "telephone_number": "903-877-6514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W LAUREL AVE",
            "city": "EUNICE",
            "state": "LA",
            "postal_code": "705352902",
            "telephone_number": "337-457-4827",
            "fax_number": "337-457-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "DUCOTE",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR - PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "903-534-3478"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "006545",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "006545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super 1 Pharmacy #637",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eunice, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; 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.

Verify at the official NPI Registry.