BROOKSHIRES PHARMACY
NPI 1003989575
Pharmacy - Community/Retail Pharmacy in Tyler, TX
NPI Status: Active since November 15, 2006
Contact Information
100 RICE RD
ATTENTION PHARMACY DEPT
TYLER, TX
ZIP 75703
Phone: (903) 561-7943
Fax: (903) 561-8239
- Organization
- Pharmacy
- Community/Retail Pharmacy
- Accepts Insurance
- CLIA Number: 45D2154881
- CLIA Cert. Type: Pharmacy
- CLIA Exp. Date: 09-19-2026
About BROOKSHIRES PHARMACY
This page provides the complete NPI Profile along with additional information for Brookshires Pharmacy, a provider established in Tyler, Texas operating as a Pharmacy, focusing in community/retail pharmacy . The healthcare provider is registered in the NPI registry with number 1003989575 assigned on November 2006. The practitioner's primary taxonomy code is 3336C0003X with license number 22621 (TX). The provider is registered as an organization and their NPI record was last updated 9 years ago. The provider's is doing business as Brookshires Pharmacy. The authorized official of this NPI record is Jim Cousineau Rph (Vp Pharmacy Operations)
- NPI
- 1003989575
- Provider Legal Name
- BROOKSHIRE GROCERY COMPANY
- Other Organization Name
- BROOKSHIRES PHARMACY
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 100 RICE RD ATTENTION PHARMACY DEPT TYLER, TX 75703
- Location Phone
- (903) 561-7943
- Location Fax
- (903) 561-8239
- Mailing Address
- 1600 W SW LOOP 323 PO BOX 1411 TYLER, TX 75701
- Mailing Phone
- (903) 877-6827
- Mailing Fax
- (903) 561-8239
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-15-2006
- Last Update Date
- 08-10-2016
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pharmacy Community/Retail Pharmacy
- Taxonomy Code
- 3336C0003X
- Type
- Suppliers
- License No.
- 22621
- License State
- TX
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 333600000X | Suppliers | Pharmacy |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Max 70/50 $6700 - PPO
- Blue Max 90/70 $1500 - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan - PPO
- Blue Saver 60/40 $6100 - PPO
- Blue Saver 90/70 $3200 - PPO
- Blue Connect 80/60 $3200 (L) - POS
- Blue Connect 80/60 $3200 (N) - POS
- Blue Connect 80/60 $3200 (S) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (L) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (N) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (S) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (L) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (N) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (S) - POS
- Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (L) - POS
- Moda Health Affinity Bronze 7750 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Essential Bronze 6500 - POS
- Essential Gold 1500 - POS
- Freedom Silver 4000 - POS
- Savings Bronze 7700 - POS
- Standard Bronze 7500 - POS
- Standard Gold 1500 - POS
- Standard Silver 5000 - POS
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 2098767 | OTHER (01) | PK | |
| 465401 | MEDICAID (05) | TX | |
| 1012120119 | MEDICARE NSC (07) |
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Adm sarscov2 100mcg/0.5ml3rd
Adm sarscov2 30mcg/0.3ml 3rd
Adm sarscov2 50mcg/0.25mlbst
Adm sarscv2 30mcg trs-sucr b
Administration of influenza virus vaccine
Administration of pneumococcal vaccine
Fee covid-19 vac 13 res
Fee covid-19 vac 14 res
Influenza vaccine split virus, preservative free
Influenza vaccine, quadrivalent derived from recombinant dna
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count
This is the administration of a third dose of a SARS-CoV-2 vaccine, given in a dose of 100 micrograms in 0.5 milliliters. This vaccine helps your body develop immunity against the COVID-19 virus. It's a crucial step in protecting your health.
This service was performed 14 times for 14 patientsThis refers to the administration of a 30 microgram dose of a SARS-CoV-2 vaccine in a 0.3 milliliter volume. It's the third dose, often referred to as a booster shot, which helps to strengthen your body's immune response against the COVID-19 virus.
This service was performed 13 times for 13 patientsThis procedure involves administering a dose of a SARS-CoV-2 vaccine. The specific dosage is 50 micrograms in a 0.25 milliliter booster shot. This vaccine helps your body build immunity against the COVID-19 virus. It's a key part of global efforts to control the pandemic.
This service was performed 138 times for 137 patientsThis service involves the administration of a 30mcg dose of the SARS-CoV-2 vaccine, which helps protect against COVID-19. The 'trs-sucr b' indicates it's stabilized with sugars for effectiveness. It's a crucial step in maintaining your health during the pandemic.
This service was performed 64 times for 64 patientsThe administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
This service was performed 213 times for 211 patientsThe pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
This service was performed 14 times for 14 patientsThe "Fee Covid-19 Vac 13 Res" service refers to a charge for the 13th dose of the Covid-19 vaccine, typically for individuals requiring additional doses due to specific health conditions. It's crucial to follow your healthcare provider's advice for your health safety.
This service was performed 42 times for 42 patientsThe "Fee covid-19 vac 14 res" refers to a charge for a specific service related to the COVID-19 vaccine. This could be for administering the vaccine or related care. It's crucial to get vaccinated to protect against the virus. The fee ensures quality service.
This service was performed 117 times for 117 patientsThe Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
This service was performed 175 times for 175 patientsThe quadrivalent influenza vaccine, made through recombinant DNA technology, is a flu shot that protects against four different flu viruses. This vaccine is produced by genetically modifying a virus, making it safer and more effective. It's a key tool in preventing flu-related illnesses.
This service was performed 34 times for 33 patientsThe Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
This service was performed 14 times for 14 patientsThis service provides a FDA-approved COVID-19 test kit for personal use. The test is self-administered and self-collected, meaning you conduct the test yourself. The kit contains all necessary items for one test. Follow the instructions carefully to ensure accurate results.
This service was performed 76 times for 13 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D2154881
- Facility Type
- Pharmacy
- Certificate Effective Date
- September 20, 2024
- Certificate Expiration Date
- September 19, 2026
- Laboratory Director
- JENNIFER KONIECZNY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Brookshires Pharmacy to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 0 | 3 | 9 | 8 | 9 | 5 | 7 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 18 | 8 | 18 | 5 | 14 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 1 + 8 + 8 + 1 + 8 + 5 + 1 + 4 + 24 = 65 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 65 = 5 | 5 | ||||||||
The NPI number 1003989575 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1821635160 | DR. JENNIFER KONIECZNY PHARMD Individual | Pharmacist | 100 RICE RD TYLER, TX 75703 (903) 561-7943 |
| 1275171118 | HENNA VAZIRANI PHARMD Individual | Pharmacist | 100 RICE RD TYLER, TX 75703 (903) 561-7943 |
| 1144907957 | WALGREEN CO. Organization | Pharmacy | 100 RICE RD TYLER, TX 75703 (903) 561-7943 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1003989575, enumerated in the NPI registry as an "organization" on November 15, 2006
The provider is located at 100 Rice Rd Attention Pharmacy Dept Tyler, Tx 75703 and the phone number is (903) 561-7943
This medical organization specializes in Pharmacy with taxonomy code 3336C0003X with a focus in Community/Retail Pharmacy
The provider might be accepting Accepts: Blue Cross and Blue Shield of Louisiana, HMO. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The most common procedures or services performed by this practitioner are: Adm sarscov2 100mcg/0.5ml3rd, Adm sarscov2 30mcg/0.3ml 3rd, Adm sarscov2 50mcg/0.25mlbst, Adm sarscv2 30mcg trs-sucr b, Administration of influenza virus vaccine, Administration of pneumococcal vaccine, Fee covid-19 vac 13 res, Fee covid-19 vac 14 res, Influenza vaccine split virus, preservative free, Influenza vaccine, quadrivalent derived from recombinant dna, Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use and Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count.
The provider's CLIA number is 45D2154881 for a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on November 15, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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