Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Bixby, OK
NPI 1194076216 · NPPES record last updated May 1, 2025
Key facts
- NPI
- 1194076216
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 11116 S Memorial Dr
Bixby, OK 74008-2038 - Phone
- (918) 970-4919
- Fax
- (918) 970-2790
- NPI assigned
- Sep 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Neil Ducote
- Title
- VP Pharmacy
- Phone
- (903) 600-1376
Other NPIs on the same Medicare enrollment 17
Corporate family (same tax ID) 20
Practitioners 1
-
Phyllis Renee Cuaderes, D.PH.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2273887 | Reasor'S Pharmacy #922 | Certificate of waiver | Dec 19, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- Brookshire Grocery Company
Locations
200 W Choctaw St
Tahlequah, OK 74464
Phone (918) 456-4797
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes | ||
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2137130 | Other | PK | |
| 100244350N | Medicaid | OK |
Other names
- Reasor's Pharmacy #22
- Reasor's Pharmacy #922
Other providers in Bixby, OK
- Dameko Brewer
- Brian S. Hicks D.C. Inc PC
- Bright Future Primary Care of Bixby
- Jacqueline Elane Briscoe
- Julie Vang Broaddrick
- Michael T Brummert
- Brush Dentistry LLC
- Amber Dawn Burdette
- Stephanie Diane Burleson
- Casey Marie Cale
All providers in Bixby, OK · Community/Retail Pharmacy in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.