Brookshire Grocery Company
Organization Active NPI Community/Retail Pharmacy · Daingerfield, TX
NPI 1841363314 · NPPES record last updated Aug 15, 2016
Key facts
- NPI
- 1841363314
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 19603 (TX)
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 609 Linda Dr
Attention Pharmacy Dept
Daingerfield, TX 75638-2115 - Phone
- (903) 645-4552
- Fax
- (903) 645-4392
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Jim Cousineau, RPH
- Title
- VP Pharmacy Operations
- Phone
- (903) 877-6514
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 |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 19603 | TX | Yes |
Addresses
Primary practice location
609 Linda Dr
Attention Pharmacy Dept
Daingerfield, TX 75638-2115
Mailing address
1600 W SW Loop 323
PO Box 1411
Tyler, TX 75701-8532
Phone (903) 877-6827
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 464314 | Medicaid | TX | |
| 2092406 | Other | PK |
Other names
- BROOKSHIRES PHARMACY
Other providers in Daingerfield, TX
- Autumn Marie Barnard
- Maria Bello
- Misty Hallonquist Blalock
- Lynn Bourdon
- Daingerfield-Lone Star Isd
- Dickinson & Wells PLLC
- Ronald Dickinson
- East Texas Medical Center Gilmer
- Elitecare DME LLC
All providers in Daingerfield, 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 Aug 15, 2016. 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.