MEDICARE: BROOKSHIRE BROTHERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	20928	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2099699	OTHER		PK

General Provider Information

NPI Number	:	1013017458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSHIRE BROTHERS INC

Provider Business Mailing Address
First Line	:	1201 ELLEN TROUT DR
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75904-1233
Country	:	US
Telephone Number	:	936-634-8155
Fax Number	:	936-633-4678

Provider Business Practice Location Address
First Line	:	295 HIGHWAY 105 E
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659-7783
Country	:	US
Telephone Number	:	409-287-3525
Fax Number	:	409-287-2295

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	JOHN ALSTON
Credential	:
Telephone Number	:	936-634-8155

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	11/19/2020

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Directions to “BROOKSHIRE BROTHERS INC ” Practice Location

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