BROOKSHIRE GROCERY COMPANY (NPI# 1073686309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073686309 |
| Entity Type | Organization |
| Organization Name | BROOKSHIRE GROCERY COMPANY |
| Other Organization Name | SUPER 1 PHARMACY |
| Practice Address |
1105 E Gentry Pkwy Attention Pharmacy Dept Tyler TX 75702-4715 |
| Mailing Address |
1600 W Sw Loop 323 Po Box 1411 Tyler TX 75701-8532 |
| Practice Telephone | 9035359467 |
| Practice Fax Number | 9035359468 |
| Mailing Telephone | 9038776827 |
| Mailing Fax Number | 9038773820 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2016-11-22 |
| Authorized Official Name | JIM COUSINEAU (VP PHARMACY OPERATIONS) |
| Authorized Official Telephone | 9038776514 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
16238 | TX | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 463965 | 05 | |
| PK | 2104432 | 01 |
| Other Name | Type Code |
|---|---|
| SUPER 1 PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386147627 | Brookshire Grocery Company | Pharmacy | 420 Hospital Rd, New Roads, LA 70760-2623 | 2018-03-13 |
| 1295248672 | Brookshire Grocery Company | Pharmacy | 1500 Bonin Rd, Youngsville, LA 70592-5102 | 2017-11-08 |
| 1750811295 | Brookshire Grocery Company | Pharmacy | 200 Destination Pointe Ln., Scott, LA 70583 | 2017-06-18 |
| 1962874602 | Brookshire Grocery Company | Pharmacy | 172 Centennial Pkwy, Tyler, TX 75703 | 2015-10-21 |
| 1033592514 | Brookshire Grocery Company | Pharmacy | 1801 N 18th St, Monroe, LA 71201-4401 | 2015-07-02 |
| 1518300086 | Brookshire Grocery Company | Pharmacy | 2300 W Ennis Ave, Ennis, TX 75119-8039 | 2013-04-15 |
| 1710227202 | Brookshire Grocery Company | Pharmacy | 11205 N Hwy 289, Pottsboro, TX 75076 | 2013-02-21 |
| 1538407416 | Brookshire Grocery Company | Pharmacy | 1001 Joshua Station Boulevard, Joshua, TX 76058 | 2013-01-28 |
| 1487907051 | Brookshire Grocery Company | Pharmacy | 1200 S 3rd St, Mabank, TX 75147-7679 | 2012-10-19 |
| 1003182122 | Brookshire Grocery Company | Pharmacy | 3916 Ne Evangeline Trwy, Carencro, LA 70520-5972 | 2012-03-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Brookshire Grocery Company | 2 South Salisbury Street, Raleigh, NC 27601 |
| Washington State Corporations | BROOKSHIRE GROCERY COMPANY | 505 Union Ave Se Ste 120, Olympia, WA 98501 |
| Street Address |
1105 E GENTRY PKWY ATTENTION PHARMACY DEPT |
| City | TYLER |
| State | TX |
| Zip Code | 75702-4715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588270052 | Jacob Williamson | Pharmacist | 1105 E Gentry Pkwy, Tyler, TX 75702-4715 | 2020-09-21 |
| 1275159493 | Hector Gutierrez | Pharmacist | 1105 E Gentry Pkwy, Tyler, TX 75702-4715 | 2020-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679116610 | Tiffiney Mcmakin | Nurse Practitioner | 810 E Houston St # 100, Tyler, TX 75702 | 2019-10-22 |
| 1659852507 | Krystal Gayle Lilley | Licensed Vocational Nurse | 100 E Ferguson St Ste 60a, Tyler, TX 75702 | 2018-08-28 |
| 1679029383 | Cynthia Lynn Kalawe | Physical Therapist | 100 E Ferguson, Suite 1204, Tyler, TX 75702 | 2016-09-01 |
| 1649623646 | Susan E Oxford | Social Worker | 13495 Frankston Highway, Tyler, TX 75702 | 2016-07-14 |
| 1053769281 | All Kidz Kan | Home Health | 2902 E Front St, Tyler, TX 75702 | 2016-05-27 |
| 1821415639 | Heather Mullins | Physical Therapy Assistant | 100 E. Ferguson Ste.1204, Tyler, TX 75702 | 2014-03-19 |
| 1346671336 | Dennis Keith Johnson | Dentist | 3081 Hwy. 31 East, Tyler, TX 75702 | 2013-12-02 |
| 1275882201 | Bobby Gibson | Counselor | 401 East Front Street, Ste 233, Tyler, TX 75702 | 2012-09-06 |
| 1144596792 | Tina Marie Borke | Clinical Neuropsychologist | 719 West Front St., Tyler, TX 75702 | 2012-03-28 |
| 1457629529 | James Whaley Rapp | Specialist/Technologist | 430 South Beckham Avenue, Trinity Mother Frances Sports Medicine, Tyler, TX 75702 | 2011-12-05 |
| Find all providers in zip 75702 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508485871 | Tyler Carerx LLC | Pharmacy | 1007 E 2nd St, Tyler, TX 75701-3312 | 2020-04-15 |
| 1225498991 | Savrx Pharmacy, Inc | Pharmacy | 6100 S. Broadway Ave, Suite 160, Tyler, TX 75703 | 2016-02-24 |
| 1043684228 | Fred's Stores of Tennessee Inc. | Pharmacy | 1803 E Gentry Pkwy, Tyler, TX 75702-3564 | 2015-11-25 |
| 1962874602 | Brookshire Grocery Company | Pharmacy | 172 Centennial Pkwy, Tyler, TX 75703 | 2015-10-21 |
| 1619143732 | Brookshire Grocery Company | Pharmacy | 1600 Wsw Loop 323, Tyler, TX 75701-8532 | 2008-05-08 |
| 1750485587 | Cvs Pharmacy Inc | Pharmacy | 4922 S Broadway Ave, Tyler, TX 75703-1324 | 2006-09-12 |
| 1235243221 | Majors Pharmacy Inc | Pharmacy | 108 Shelley Dr, Tyler, TX 75701-8723 | 2006-08-18 |
| 1700808458 | Cvs Pharmacy Inc | Pharmacy | 7003 S Broadway Ave, Tyler, TX 75703-4737 | 2006-07-24 |
| 1356955587 | American Specialty Pharmacy Inc | Pharmacy | 1109 E 5th St, Tyler, TX 75701-3318 | 2020-09-04 |
| 1336751270 | Stephenson Pharmacy, LLC | Pharmacy | 1000 S Fleishel Ave, Tyler, TX 75701-2037 | 2020-08-21 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.