Brookshire Grocery Company

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

15550 Issued in TX

Legal business name

BROOKSHIRE GROCERY COMPANY

Doing business as

Brookshires Pharmacy

Practice address

20100 St Hwy 155 S
Attention Pharmacy Dept
Flint, TX 75762-4620

Phone

(903) 825-7418

Fax

(903) 825-7426

NPI assigned

Nov 16, 2006

Last updated

Jun 24, 2016By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• BROOKSHIRES PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1437222767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W SW LOOP 323",
            "address_2": "PO BOX 1411",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018532",
            "telephone_number": "903-877-6827",
            "fax_number": "903-877-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20100 ST HWY 155 S",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "FLINT",
            "state": "TX",
            "postal_code": "757624620",
            "telephone_number": "903-825-7418",
            "fax_number": "903-825-7426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2016-06-24",
        "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": "TX",
            "license": "15550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2101025",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463943",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKSHIRES PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Bockover
• Ran Bolen
• Zane Boles, PT, DPT
• Nancy M. Boone, RN
• Eric William Brabon, APRN, FNP-C
• Roger Andrew Burshe
• Tamela Renae Callahan, FNP-C
• Y Huynnhu Chau, RN
• Sarah Ann Clark, L.C.S.W.
• Tamela Renee Clary, LMSW

• Community/Retail Pharmacy in Flint, TX
• Providers in Flint, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; 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.