Brookshire Grocery Company

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

20343 Issued in TX

Legal business name

BROOKSHIRE GROCERY COMPANY

Doing business as

SUPER 1 PHARMACY

Practice address

1800 S High St
Attention Pharmacy Dept
Longview, TX 75602-3210

Phone

(903) 234-2785

Fax

(903) 234-2789

NPI assigned

Nov 16, 2006

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

• SUPER 1 PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debbie Lynette Sharp, RPH

  • Pharmacist
  • Longview, TX
  • NPI 1447632963
  NPD (past)
• Shaan Noonan Novak Welch

  • Pharmacist
  • Longview, TX
  • NPI 1043825995
  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462752000000",
    "number": "1649343971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BROOKSHIRE GROCERY COMPANY",
            "address_2": "PO BOX 1411",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757101411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 S HIGH ST",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756023210",
            "telephone_number": "903-234-2785",
            "fax_number": "903-234-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2016-05-09",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "20343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2093497",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "464505",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER 1 PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gene Bronson, TX LPC 14451
• Brookridge Internal Medicine Associates, PA
• Chandler Dyan Brooks, FNP
• Clay Brooks, LPC
• Delisa Lynn Brooks, APRN,FNP-C, PMHNP-BC
• Brookshire Grocery Company
• Brookshire Grocery Company
• Jo Ann Broquie, LPC, LSSP
• Elizabeth Brouillette, PA, APRN
• Becky Lynn Brown

• Community/Retail Pharmacy in Longview, TX
• Providers in Longview, 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 May 9, 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.