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Contact Information

BROOKSHIRE GROCERY COMPANY
502C EAST GOODE
ATTENTION PHARMACY DEPT
QUITMAN, TX75783
 Phone: 903-763-1420
 Fax: 903-763-3360
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for BROOKSHIRE GROCERY COMPANY

NPI Number 1710050042
LBN Legal business name BROOKSHIRE GROCERY COMPANY
Authorized official JIM COUSINEAU - (VP PHARMACY OPERATIONS)
Entity Organization
Organization subpart 1 No
Enumeration date 11/16/2006
Last updated 12/22/2015 - About 10 years ago
Identifiers
TX License # 21430
TX Medicaid 465214
Other 2097329 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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