Brookshire Grocery Company

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28377 Issued in TX

Legal business name

BROOKSHIRE GROCERY COMPANY

Doing business as

Brookshire Pharmacy #88

Practice address

2300 W Ennis Ave
Ennis, TX 75119-8039

Phone

(972) 875-4607

Fax

(972) 875-2060

NPI assigned

Apr 15, 2013

Last updated

Jul 30, 2013By 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

Title

Sr VP Pharmacy Ops

Phone

(903) 877-6829

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Brookshire Pharmacy #88 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1518300086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1411",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757101411",
            "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": "2300 W ENNIS AVE",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751198039",
            "telephone_number": "972-875-4607",
            "fax_number": "972-875-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-15",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "COUSINEAU",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "SR VP PHARMACY OPS",
        "authorized_official_telephone_number": "903-877-6829"
    },
    "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": "28377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2139824",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookshire Pharmacy #88",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bluebonnet Medical Care PA (Ennis Quick Care)
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• Braces R US PC
• Broadright Counseling Services, LLC
• Brookdale Senior Living Communities, Inc. (Brookdale Ennis)
• Julia Penelope Brown, PT
• Katherine Elizabeth Brown, M.D.
• Klebe Brumble, RNFA
• Karen J Burns, LPC
• Burt Enterprises LLC (Generation Durable Medical Equip)

• Community/Retail Pharmacy in Ennis, TX
• Providers in Ennis, 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 Jul 30, 2013; 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.