Brookshire Grocery Company

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

17269 Issued in TX

Legal business name

BROOKSHIRE GROCERY COMPANY

Doing business as

Brookshires Pharmacy

Practice address

306 State Hwy 37 South
Attention Pharmacy Dept
Mt Vernon, TX 75457

Phone

(903) 537-2886

Fax

(903) 537-2887

NPI assigned

Nov 16, 2006

Last updated

Aug 10, 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

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470787200000",
    "number": "1609949932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 513",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "MT VERNON",
            "state": "TX",
            "postal_code": "754570513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 STATE HWY 37 SOUTH",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "MT VERNON",
            "state": "TX",
            "postal_code": "75457",
            "telephone_number": "903-537-2886",
            "fax_number": "903-537-2887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2016-08-10",
        "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": "17269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2106051",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463937",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKSHIRES PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Ramsay Bentley, FNP-C
• Misty Bickham
• Dylan Blair, LCSW
• Boatright Nursing Centers Inc (Mission Manor)
• Diamond Briones, PTA
• Zachary Allen Buck, DPT
• Jonathan Marc Burrows, DDS
• Daniel Carr, LPC
• Chartwell Community Services, Inc. (Jordan Health Services, a Part of the Elara Caring Network)
• Laure Colvin, LPC

• Community/Retail Pharmacy in Mount Vernon, TX
• Providers in Mount Vernon, 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 Aug 10, 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.