Super 1 Pharmacy

LBN: Brookshire Grocery Company
Super 1 Pharmacy is an health care organization with primary practice located at 1217 E Marshall Ave Attention Pharmacy Dept, Longview TX 75601-5604. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Brookshire Grocery Company can be contacted via phone (903) 753-1964, or through Cousineau, Jim via phone (903) 877-6514.

Contact Information

Primary practice address
1217 E Marshall Ave Attention Pharmacy Dept Longview TX 75601-5604
Phone: (903) 753-1964
Fax: (903) 753-1965
Website:
Map and Directions
Authorized official contact:
Name: Cousineau, Jim RPH
Phone: (903) 877-6514

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 15785 Texas

Profile Details

NPI number 1811060387
LBN Legal business name Brookshire Grocery Company
DBA Doing business as Super 1 Pharmacy
Authorized official Cousineau, Jim RPH
Entity Organization
Organization subpart 1 No
Enumeration date Nov 15th, 2006
Last updated Mar 30th, 2016 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811060387 NPPES
Texas MEDICAID 463942
Texas Other 2102369

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