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BROOKSHIRE GROCERY COMPANY NPI 1811060387


NPI Information

NPI: 1811060387
Provider Name: BROOKSHIRE GROCERY COMPANY

Doing Business As: SUPER 1 PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 45D2183808

Address:
1217 E MARSHALL AVE
ATTENTION PHARMACY DEPT
LONGVIEW, TX
ZIP 75601
Phone: (903) 753-1964
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BROOKSHIRE GROCERY COMPANY is a community/retail pharmacy pharmacy in Longview, TX. The provider is 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. BROOKSHIRE GROCERY COMPANY NPI is 1811060387. The provider is registered as an organization entity type.
The provider Is Doing Business As Super 1 Pharmacy.

The provider's business location address is:

1217 E MARSHALL AVE
ATTENTION PHARMACY DEPT
LONGVIEW, TX
ZIP 75601-604
Phone: (903) 753-1964
Fax: (903) 753-1965

The provider's authorized official is Jim Cousineau .
The authorized official title is Vp Pharmacy Operations and has the following contact phone number (903) 877-6514.

The CLIA number assigned to this NPI record is 45D2183808 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/15/2006 and was last updated on 3/30/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail Pharmacy15785TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12102369OTHERPK
21012120003MEDICARE NSC
3463942MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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