Healthcare Provider Details

I. General information

NPI: 1518066836
Provider Name (Legal Business Name): BROOKSHIRE BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST
BRYAN TX
77803-3236
US

IV. Provider business mailing address

1201 ELLEN TROUT DR
LUFKIN TX
75904-1233
US

V. Phone/Fax

Practice location:
  • Phone: 979-822-1383
  • Fax: 979-779-2657
Mailing address:
  • Phone: 936-634-8155
  • Fax: 936-633-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24174
License Number StateTX

VIII. Authorized Official

Name: JOHN ALSTON
Title or Position: PRESIDENT CEO
Credential:
Phone: 936-634-8155