Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Anna, TX
NPI 1740448174 · NPPES record last updated Nov 1, 2012
Key facts
- NPI
- 1740448174
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 25923 (TX)
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 1325 W White St
Anna, TX 75409-5007 - Phone
- (972) 924-4220
- Fax
- (972) 924-4773
- NPI assigned
- Jun 2, 2008
- Organization subpart
- No
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP of Phcy Oper
- Phone
- (903) 877-6829
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080801000492 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 1355415712 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 25923 | TX | Yes |
Addresses
Primary practice location
1325 W White St
Anna, TX 75409-5007
Mailing address
PO Box 1411
Tyler, TX 75710-1411
Phone (903) 877-6514
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4548333 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- BROOKSHIRE PHARMACY
Other providers in Anna, TX
- Brandon Boley
- Mary Kaitlyn Boley
- Branches Dental, PLLC
- Lauren Elizabeth Brock
- Alexandra Brooks
- Hannah Brown
- Tamara Shearer Brown
- Zoe Burgett
- Michael Leslie Calvert
- Donald Chen
All providers in Anna, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.