Active NPI
Brookshire Grocery Company
- Community/Retail Pharmacy
- Greenville, TX
National Provider Identifier
1992878466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 16080
- Legal business name
- BROOKSHIRE GROCERY COMPANY
- Practice address
- 4811 Wesley St
Attention Pharmacy Dept
Greenville, TX 75401-5649 - Phone
- (903) 454-8701
- Fax
- (903) 454-6089
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 16080 | TX | Primary |
Addresses
Primary practice location
4811 Wesley St
Attention Pharmacy Dept
Greenville, TX 75401-5649
Mailing address
1600 W SW Loop 323
PO Box 1411
Tyler, TX 75701-8532
Phone (903) 877-6827
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 463968 | Medicaid | TX | |
| 2104414 | Other | PK |
Other names 1
- SUPER 1 PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| 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
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1466640000000",
"number": "1992878466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 W SW LOOP 323",
"address_2": "PO BOX 1411",
"city": "TYLER",
"state": "TX",
"postal_code": "757018532",
"telephone_number": "903-877-6827",
"fax_number": "903-877-3820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4811 WESLEY ST",
"address_2": "ATTENTION PHARMACY DEPT",
"city": "GREENVILLE",
"state": "TX",
"postal_code": "754015649",
"telephone_number": "903-454-8701",
"fax_number": "903-454-6089"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOKSHIRE GROCERY COMPANY",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2016-06-23",
"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": "16080",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "463968",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2104414",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SUPER 1 PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Greenville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.