Brookshire Grocery Company

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27158 Issued in TX

Legal business name

BROOKSHIRE GROCERY COMPANY

Doing business as

Brookshire Pharmacy

Practice address

1203 US Highway 380
Bridgeport, TX 76426-2087

Phone

(940) 683-1510

Fax

(940) 683-1515

NPI assigned

Oct 26, 2010

Last updated

Nov 1, 2012By 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

Senior VP of Phrmacy Ops.

Phone

(903) 877-6829

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BROOKSHIRE 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": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1710287602",
    "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": "903-877-6862",
            "fax_number": "903-877-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 US HIGHWAY 380",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262087",
            "telephone_number": "940-683-1510",
            "fax_number": "940-683-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "COUSINEAU",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "SENIOR VP OF PHRMACY OPS.",
        "authorized_official_telephone_number": "903-877-6829"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5901500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKSHIRE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bridgeport Care Center, Inc (Bridgeport Care Center)
• Bridgeport Emergency Medicine Associates PA
• Bridgeport Essential Practices, LLC (Bridgeport Health Care Center)
• Bridgeport Isd
• Laurie Briggle
• Elva Alejandro Camero, M.D
• Jon Wayne Copeland, D.O.
• Christine Marie Cox, APRN
• Dan C. Selz DDS Deborah J. Selz DDS
• David a Ray D O P a

• Community/Retail Pharmacy in Bridgeport, TX
• Providers in Bridgeport, 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 Nov 1, 2012; 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.