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SUPER 1 FOODS PHARMACY #642
NPI 1962874602
Pharmacy in Tyler, TX

Active since October 21, 2015
172 CENTENNIAL PKWY, TYLER, TX 75703(903) 525-6923(903) 581-2421 Get Directions Write a Review

NPPES record last updated: September 21, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 21, 2016, Dec 10, 2015 (2 updates tracked since 2015).

About Super 1 Foods Pharmacy #642 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUPER 1 FOODS PHARMACY #642 (NPI 1962874602) is a healthcare organization registered as a pharmacy in Tyler, Texas and active in the NPI registry since October 2015. The organization lists Jim Cousineau, Senior Vp Pharmacy Operations, as its authorized official.

NPPES Registry Identity

NPI1962874602
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameBROOKSHIRE GROCERY COMPANY
Location Address172 CENTENNIAL PKWYTyler, TX 75703
Mailing AddressPo Box 1411, Attention Pharmacy DepartmentTyler, TX 75710-1411 · (903) 877-6862 · Fax (903) 877-3820
Phone(903) 525-6923
Fax(903) 581-2421
Organization SubpartNo
Authorized OfficialJim CousineauSenior Vp Pharmacy Operations · (903) 877-6829
Enumeration DateOctober 21, 2015
Last NPPES UpdateSeptember 21, 20162 updates tracked since enumeration
✔ NPI 1962874602 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in TX · 30243
Definition
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.
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
172 CENTENNIAL PKWY, Tyler, TX 75703
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Other Names 1

Doing Business AsSuper 1 Foods Pharmacy #642

Other Identifiers 2

Other2154729Pk
Medicaid470992TX

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Moda Health Plan, Inc..Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WALGREEN CO.
Pharmacy
172 CENTENNIAL PKWY
TYLER, TX 75703
Smith County (903) 525-6923

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brookshire Grocery Company's NPI number?

The NPI number for Brookshire Grocery Company is 1962874602. It was assigned to this organization in the NPPES registry on October 21, 2015. The provider is doing business as Super 1 Foods Pharmacy #642.

Where is Brookshire Grocery Company located?

Brookshire Grocery Company is located at 172 Centennial Pkwy, Tyler, TX 75703. The listed phone number is (903) 525-6923.

What is Brookshire Grocery Company's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

What insurance does Brookshire Grocery Company accept?

Health plans from Medica and Moda Health Plan, Inc. list Brookshire Grocery Company as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brookshire Grocery Company was last updated on September 21, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.