Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Corsicana, TX
NPI 1164595492 · NPPES record last updated Aug 10, 2016
Key facts
- NPI
- 1164595492
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 15943 (TX)
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 800 N Main St Ste a
Attention Pharmacy Dept
Corsicana, TX 75110-3053 - Phone
- (903) 874-1111
- Fax
- (903) 874-1112
- NPI assigned
- Nov 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 15943 | TX | Yes |
Addresses
Primary practice location
800 N Main St Ste a
Attention Pharmacy Dept
Corsicana, TX 75110-3053
Mailing address
1600 W SW Loop 323
PO Box 1411
Tyler, TX 75701-8532
Phone (903) 877-6827
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2103966 | Other | PK | |
| 463940 | Medicaid | TX |
Other names
- BROOKSHIRES PHARMACY
Other providers in Corsicana, TX
- Kalin Bracero
- Brighter Horizon Pediatrics PLLC
- Brock Medical, PLLC
- Jana Johnson Brock
- Brookdale Senior Living Communities, Inc.
- Brookshire Grocery Company
- Caren Lynette Brown-Smith
- Kelly Brown
- Rachel Marie Bruce
- Vernon Miles Bryder
All providers in Corsicana, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2016. 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.