BROOKSHIRE GROCERY COMPANY (NPI# 1962874602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962874602 |
| Entity Type | Organization |
| Organization Name | BROOKSHIRE GROCERY COMPANY |
| Other Organization Name | SUPER 1 FOODS PHARMACY #642 |
| Practice Address |
172 Centennial Pkwy Tyler TX 75703 |
| Mailing Address |
Po Box 1411 Attention Pharmacy Department Tyler TX 75710-1411 |
| Practice Telephone | 9035256923 |
| Practice Fax Number | 9035812421 |
| Mailing Telephone | 9038776862 |
| Mailing Fax Number | 9038773820 |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2016-09-21 |
| Authorized Official Name | JIM COUSINEAU (SENIOR VP PHARMACY OPERATIONS) |
| Authorized Official Telephone | 9038776829 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | 30243 | TX | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2154729 | 01 | |
| TX | 470992 | 05 |
| Other Name | Type Code |
|---|---|
| Super 1 Foods Pharmacy #642 | 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 |
| 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 |
| 1083910137 | Brookshire Grocery Company | Pharmacy | 6991 Old Jacksonville Hwy, Tyler, TX 75703-0579 | 2011-02-08 |
| 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 |
172 CENTENNIAL PKWY |
| City | TYLER |
| State | TX |
| Zip Code | 75703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| 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: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845827 | 62 Roses Wellness, LLC | Pharmacy | 3320 Troup Hwy Ste 140, Tyler, TX 75701-8358 | 2020-06-09 |
| 1629601489 | Kvb LLC | Pharmacy | 13027 Hwy 155 S Ste 200, Tyler, TX 75703-6548 | 2020-02-19 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| 1427323005 | Pharmscript of Texas LLC | Pharmacy | 5012 Profit Dr Ste B, Tyler, TX 75707-1839 | 2012-03-15 |
| 1083910137 | Brookshire Grocery Company | Pharmacy | 6991 Old Jacksonville Hwy, Tyler, TX 75703-0579 | 2011-02-08 |
| 1629136460 | Woody Weaver Pharmacy | Pharmacy | 2722 West Gentry Parkway, Tyler, TX 75702 | 2006-12-05 |
| 1003989336 | Brookshire Grocery Company | Pharmacy | 2734 E 5th St, Attention Pharmacy Dept, Tyler, TX 75701-5021 | 2006-11-16 |
| 1255404588 | Brookshire Grocery Company | Pharmacy | 3828 Troup Hwy, Attention Pharmacy Dept, Tyler, TX 75703-1726 | 2006-11-16 |
| 1790858025 | Brookshire Grocery Company | Pharmacy | 113 N Nw Loop 323, Attention Pharmacy Dept, Tyler, TX 75702-8725 | 2006-11-16 |
| 1073686309 | Brookshire Grocery Company | Pharmacy | 1105 E Gentry Pkwy, Attention Pharmacy Dept, Tyler, TX 75702-4715 | 2006-11-16 |
| 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.