Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Lafayette, LA
NPI 1124191697 · NPPES record last updated Sep 19, 2025
Key facts
- NPI
- 1124191697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 4111 (LA)
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 215 W Willow St
Attention Pharmacy Dept
Lafayette, LA 70501-2841 - Phone
- (318) 572-9053
- Fax
- (318) 572-9054
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
Other NPIs on the same Medicare enrollment 38
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Locations
215 W Willow St
Lafayette, LA 70501
Phone (337) 572-9053
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 4111 | LA | Yes |
Addresses
Primary practice location
215 W Willow St
Attention Pharmacy Dept
Lafayette, LA 70501-2841
Mailing address
215 West Willow Street
Attention Pharmacy Dept
Lafayette, LA 70501
Phone (318) 572-9053
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2033926 | Other | PK | |
| 1266485 | Medicaid | LA |
Other names
- SUPER 1 PHARMACY
Other providers in Lafayette, LA
- Abby Brodie
- Aramie Brooks
- Garret John Brooks
- Lorena Rochelle Brooks
- Beth P Brooksher
- Brookshire Grocery Company
- Broussard Speech Therapy, Inc.
- Aiesha Danelle Broussard
- Aimee Vidrine Broussard
- Alexis Broussard
All providers in Lafayette, LA · Community/Retail Pharmacy in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.