Brookshire Grocery Company

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BROOKSHIRE GROCERY COMPANY

Doing business as

Brookshires Pharmacy #41

Practice address

113 N Northwest Loop 323
Attention Pharmacy Dept
Tyler, TX 75702-8725

Phone

(903) 593-5369

Fax

(903) 593-3490

NPI assigned

Nov 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jim D Cousineau, RPH

Title

VP Pharmacy Operations

Phone

(903) 877-6829

Specialties & licenses 3

Addresses

Other identifiers 6

Other names 1

• BROOKSHIRES PHARMACY #41 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1922171495",
    "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": "903-593-5369",
            "fax_number": "903-877-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 N NORTHWEST LOOP 323",
            "address_2": "ATTENTION PHARMACY DEPT",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028725",
            "telephone_number": "903-593-5369",
            "fax_number": "903-593-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE GROCERY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "COUSINEAU",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "903-877-6829",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "21365",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1922171495",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IMMUNIZATION BILLING-TRAILBLAZER",
            "identifier": "PH0342",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX STATE BOARD OF PHARMACY LICENSE",
            "identifier": "21365",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4521147",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465110",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX DPS",
            "identifier": "J0122303",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKSHIRES PHARMACY #41",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brookshire Grocery Company (Brookshire Pharmacy)
• Brookshire Grocery Company (Super 1 Pharmacy)
• Brookshire Grocery Company (Brookshires Pharmacy)
• Brookshire Grocery Company
• Brookshire Grocery Company (Super 1 Pharmacy)
• Brookshire Grocery Company (Super 1 Foods Pharmacy #642)
• Daniel Ray Broom, D.C.
• La' Toya Broughton
• Matthew Brousseau
• Elizabeth Brown Ford, SLPA

• Community/Retail Pharmacy in Tyler, TX
• Providers in Tyler, 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 Mar 7, 2023; 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.