NPIMap

Organization Active NPI

Brookshire Grocery Company

  • Community/Retail Pharmacy
  • Youngsville, LA
National Provider Identifier
1295248672
Registry record updated Nov 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
007545 Issued in LA
Legal business name
BROOKSHIRE GROCERY COMPANY
Practice address
1500 Bonin Rd
Youngsville, LA 70592-5102
Phone
(337) 573-6177
Fax
(337) 837-5072
NPI assigned
Nov 8, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Trent D Brookshire
Title
Exec VP-Corporate Development
Phone
(903) 534-3000

Other NPIs on the same Medicare enrollment 38

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

View all 38

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

1500 Bonin Rd
Youngsville, LA 70592
Phone (337) 573-6176

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 007545 LA
Community/Retail Pharmacy 3336C0003X 007545 LA Primary

Addresses

NPPES NPI Registry

Primary practice location

1500 Bonin Rd
Youngsville, LA 70592-5102

Mailing address

1500 Bonin Rd
Youngsville, LA 70592-5102
Phone (337) 573-6177

Other names 1

NPPES NPI Registry
  • Super 1 Pharmacy #645 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 8, 2017.

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510099200000",
    "number": "1295248672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 BONIN RD",
            "city": "YOUNGSVILLE",
            "state": "LA",
            "postal_code": "705925102",
            "telephone_number": "337-573-6177",
            "fax_number": "337-837-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 BONIN RD",
            "city": "YOUNGSVILLE",
            "state": "LA",
            "postal_code": "705925102",
            "telephone_number": "337-573-6177",
            "fax_number": "337-837-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2017-11-08",
        "status": "A",
        "authorized_official_last_name": "BROOKSHIRE",
        "authorized_official_first_name": "TRENT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXEC VP-CORPORATE DEVELOPMENT",
        "authorized_official_telephone_number": "903-534-3000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "007545",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "007545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super 1 Pharmacy #645",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Youngsville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2017; 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.

Verify at the official NPI Registry.