BROOKSHIRE GROCERY COMPANY (NPI# 1780757252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780757252 |
| Entity Type | Organization |
| Organization Name | BROOKSHIRE GROCERY COMPANY |
| Other Organization Name | SUPER 1 PHARMACY |
| Practice Address |
2640 Waggoner Ave Attention Pharmacy Dept Shreveport LA 71108-3859 |
| Mailing Address |
1600 W Sw Loop 323 Po Box 1411 Tyler TX 75701-8532 |
| Practice Telephone | 3186312065 |
| Practice Fax Number | 3186312067 |
| Mailing Telephone | 9038776827 |
| Mailing Fax Number | 9038773820 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2015-12-22 |
| 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 |
932939 | LA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2033200 | 01 | |
| LA | 1262030 | 05 |
| 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 |
2640 WAGGONER AVE ATTENTION PHARMACY DEPT |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71108-3859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629337316 | Thomas Fisher | Pharmacist | 2640 Waggoner Ave, Shreveport, LA 71108-3859 | 2012-05-15 |
| 1578870739 | Jacqueline A Mccray | Pharmacist | 2640 Waggoner Ave, Shreveport, LA 71108-3859 | 2010-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528551140 | Berkelia Player | Case Manager/Care Coordinator | 8108 Kingston Road Suite 101 B, Shreveport, LA 71108 | 2018-06-08 |
| 1548757305 | Kenya Cawthorne | Counselor | 1520 Oakdale St, Shreveport, LA 71108 | 2018-04-17 |
| 1083112890 | Chantanell Johns | Case Manager/Care Coordinator | 8101 Kingston Rd Ste 101b, Shreveport, LA 71108 | 2018-01-26 |
| 1912425935 | Mildred Rivers | Case Manager/Care Coordinator | 4718 Hearne Ave, Shreveport, LA 71108 | 2017-08-30 |
| 1790205326 | Britney Ashton | Case Manager/Care Coordinator | 1910 Hickory St, Shreveport, LA 71108 | 2017-06-24 |
| 1548792674 | La'travia Jackson | Case Manager/Care Coordinator | 3430 Fernwood Ln, Shreveport, LA 71108 | 2017-03-29 |
| 1962941476 | Johnetta Marshall | Counselor | 6901 Despot Rd, Shreveport, LA 71108 | 2017-02-16 |
| 1295283992 | Shaun Cooper | Case Manager/Care Coordinator | 8824 Ruth Ave, Shreveport, LA 71108 | 2016-09-12 |
| 1508313735 | Tara Black | Counselor | 7019 Louise St, Shreveport, LA 71108 | 2016-09-06 |
| 1659828960 | Maranda Bolden | Counselor | 4906 Merlin Circle, Apt 4906, Shreveport, LA 71108 | 2016-09-02 |
| Find all providers in zip 71108 | ||||
| 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 |
|---|---|---|---|---|
| 1689077430 | University Health Shreveport LLC | Pharmacy | 1606 Kings Hwy Rm 2263, Shreveport, LA 71103-4128 | 2014-10-07 |
| 1104268390 | Freds Stores of Tennessee Inc | Pharmacy | 5907 Old Mooringsport Road, Shreveport, LA 71107-2023 | 2013-07-29 |
| 1619058468 | Line Avenue Pharmacy Inc | Pharmacy | 1822 Line Ave, Shreveport, LA 71101-4612 | 2006-10-18 |
| 1215031141 | Louisiana Cvs Pharmacy, L.L.C. | Pharmacy | 3300 Youree Dr, Shreveport, LA 71105-2116 | 2006-09-12 |
| 1033213962 | Louisiana Cvs Pharmacy, L.L.C. | Pharmacy | 9194 Mansfield Rd, Shreveport, LA 71118-3123 | 2006-09-12 |
| 1497760664 | Walgreen Co | Pharmacy | 3124 Line Ave, Shreveport, LA 71104-4240 | 2006-07-29 |
| 1023023298 | Walgreen Co | Pharmacy | 6101 W 70th St, Shreveport, LA 71129-2507 | 2006-07-29 |
| 1235144411 | Walgreen Co | Pharmacy | 3100 N Market St, Shreveport, LA 71107-4005 | 2006-07-29 |
| 1043225212 | Walgreen Co | Pharmacy | 300 Southfield Rd, Shreveport, LA 71105-4112 | 2006-07-29 |
| 1134134307 | Walgreen Co | Pharmacy | 3555 Greenwood Rd, Shreveport, LA 71109-5209 | 2006-07-29 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71108 |
Please comment or provide details below to improve the information on BROOKSHIRE GROCERY COMPANY.
| 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.