Active NPI
Brookshire Grocery Company
Doing business as Brookshire Pharmacy
- Community/Retail Pharmacy
- Tyler, TX
National Provider Identifier
1083910137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 27106
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Doing business as
- Brookshire Pharmacy
- Practice address
- 6991 Old Jacksonville Hwy
Tyler, TX 75703-0579 - Phone
- (903) 747-3508
- Fax
- (903) 747-3514
- NPI assigned
- Feb 8, 2011
- 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
- Title
- Sr VP Pharmacy Ops
- Phone
- (903) 877-6829
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 27106 | TX | Primary |
Addresses
Primary practice location
6991 Old Jacksonville Hwy
Tyler, TX 75703-0579
Mailing address
PO Box 1411
Tyler, TX 75710-1411
Phone (903) 877-6827
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5902425 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names 1
- Brookshire Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080801000492 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355415712 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryLocations
6991 Old Jacksonville Hwy
Tyler, TX 75703
Phone (903) 747-3508
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297123200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1353283200000",
"number": "1083910137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1411",
"city": "TYLER",
"state": "TX",
"postal_code": "757101411",
"telephone_number": "903-877-6827",
"fax_number": "903-877-3820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6991 OLD JACKSONVILLE HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "757030579",
"telephone_number": "903-747-3508",
"fax_number": "903-747-3514"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOKSHIRE GROCERY COMPANY",
"organizational_subpart": "NO",
"enumeration_date": "2011-02-08",
"last_updated": "2012-11-19",
"status": "A",
"authorized_official_last_name": "COUSINEAU",
"authorized_official_first_name": "JIM",
"authorized_official_title_or_position": "SR VP PHARMACY OPS",
"authorized_official_telephone_number": "903-877-6829"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "27106",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "5902425",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Brookshire Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tyler, TX
- Tiffany M Brooks
- Tynisha Brooks, LCDC
- Brookshire Grocery Company (Brookshires Pharmacy)
- Brookshire Grocery Company (Brookshires Pharmacy)
- Brookshire Grocery Company (Super 1 Pharmacy)
- Brookshire Grocery Company (Super 1 Pharmacy)
- Brookshire Grocery Company (Brookshires Pharmacy)
- Brookshire Grocery Company
- Brookshire Grocery Company (Super 1 Pharmacy)
- Brookshire Grocery Company (Brookshires Pharmacy #41)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2012; 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.