Active NPI
Brookshire Grocery Company
- Community/Retail Pharmacy
- Pine Bluff, AR
National Provider Identifier
1235202706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 0420004
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Doing business as
- Super 1 Foods PHARMACY
- Practice address
- 2800 S Hazel St
Attention Pharmacy Dept
Pine Bluff, AR 71603-5007 - Phone
- (870) 535-4044
- Fax
- (870) 535-8116
- NPI assigned
- Nov 15, 2006
- 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, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0420004 | AR | Primary |
Addresses
Primary practice location
2800 S Hazel St
Attention Pharmacy Dept
Pine Bluff, AR 71603-5007
Mailing address
2800 South Hazel Street
Attention Pharmacy Dept
Pine Bluff, AR 71603
Phone (870) 535-4044
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130898407 | Medicaid | AR | |
| 1988193 | Other | PK |
Other names 1
- Super 1 Foods PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091023000007 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355415712 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ashdown, AR; Arkadelphia, AR; Pine Bluff, AR; Maganolia, AR; El Dorado, AR; Crossett, AR; Camden, AR; Hope, AR |
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
2800 S Hazel St
Pine Bluff, AR 71603
Phone (870) 535-4044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1758240000000",
"number": "1235202706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 SOUTH HAZEL STREET",
"address_2": "ATTENTION PHARMACY DEPT",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "71603",
"telephone_number": "870-535-4044",
"fax_number": "870-535-8116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 S HAZEL ST",
"address_2": "ATTENTION PHARMACY DEPT",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716035007",
"telephone_number": "870-535-4044",
"fax_number": "870-535-8116"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOKSHIRE GROCERY COMPANY",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2025-09-19",
"status": "A",
"authorized_official_last_name": "COUSINEAU",
"authorized_official_first_name": "JIM",
"authorized_official_title_or_position": "VP PHARMACY OPERATIONS",
"authorized_official_telephone_number": "903-877-6514",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "AR",
"license": "0420004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130898407",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "1988193",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Super 1 Foods PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; 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.