NPIMap

Organization Active NPI

Brookshire Grocery Company

Doing business as Reasor's Pharmacy #22

  • Community/Retail Pharmacy
  • Bixby, OK
National Provider Identifier
1194076216
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BROOKSHIRE GROCERY COMPANY
Doing business as
Reasor's Pharmacy #22
Reasor's Pharmacy #922
Practice address
11116 S Memorial Dr
Bixby, OK 74008-2038
Phone
(918) 970-4919
Fax
(918) 970-2790
NPI assigned
Sep 28, 2012
Last updated
May 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Authorized official

Name
Neil Ducote
Title
VP Pharmacy
Phone
(903) 600-1376

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

11116 S Memorial Dr
Bixby, OK 74008-2038

Mailing address

1600 WSW Loop 323
Tyler, TX 75701-8532

Other identifiers 2

IdentifierTypeStateIssuer
100244350NMedicaidOK
2137130OtherPK

Other names 2

  • Reasor's Pharmacy #22 Doing business as
  • Reasor's Pharmacy #922 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240725004696 OK Part B Supplier - Mass Immunization (Roster Biller Only) 1355415712 17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sand Springs, OK; Sapulpa, OK; Tahlequah, OK; Tulsa, OK; Owasso, OK; Bixby, OK; Broken Arrow, OK; Claremore, OK…

Other NPIs on the same Medicare enrollment 17

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

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2273887Reasor's Pharmacy #92211116 S Memorial, Bixby, OK 74008Certificate of waiverDec 19, 2026

National Provider Directory

National Provider Directory
Tax ID family
Brookshire Grocery Company21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1348790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1194076216",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11116 S MEMORIAL DR",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740082038",
            "telephone_number": "918-970-4919",
            "fax_number": "918-970-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-28",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "DUCOTE",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "VP PHARMACY",
        "authorized_official_telephone_number": "903-600-1376"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244350N",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137130",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reasor's Pharmacy #22",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Reasor's Pharmacy #922",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bixby, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.