NPIMap

Organization Active NPI

Brookshire Grocery Company

Doing business as Super 1 Foods PHARMACY

  • Community/Retail Pharmacy
  • Pine Bluff, AR
National Provider Identifier
1326111899
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0420005 Issued in AR
Legal business name
BROOKSHIRE GROCERY COMPANY
Doing business as
Super 1 Foods PHARMACY
Practice address
5805 Dollarway Rd
Attention Pharmacy Dept
Pine Bluff, AR 71602-3824
Phone
(870) 247-5854
Fax
(870) 247-1782
NPI assigned
Nov 15, 2006
Last updated
Sep 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 0420005 AR Primary

Addresses

Primary practice location

5805 Dollarway Rd
Attention Pharmacy Dept
Pine Bluff, AR 71602-3824

Mailing address

5805 Dollarway Road
Attention Pharmacy Dept
Pine Bluff, AR 71602
Phone (870) 247-5854

Other identifiers 2

IdentifierTypeStateIssuer
130899407MedicaidAR
1988192OtherPK

Other names 1

  • Super 1 Foods PHARMACY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory

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": "1326111899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 DOLLARWAY ROAD",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71602",
            "telephone_number": "870-247-5854",
            "fax_number": "870-247-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5805 DOLLARWAY RD",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716023824",
            "telephone_number": "870-247-5854",
            "fax_number": "870-247-1782"
        }
    ],
    "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "0420005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130899407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1988192",
            "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.

Verify at the official NPI Registry.