Healthcare Provider Details

I. General information

NPI: 1285734624
Provider Name (Legal Business Name): BROOKSHIRE BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14761 HWY 150 WEST
COLDSPRING TX
77331
US

IV. Provider business mailing address

PO BOX 400
COLDSPRING TX
77331-0400
US

V. Phone/Fax

Practice location:
  • Phone: 936-653-8201
  • Fax: 936-653-8203
Mailing address:
  • Phone: 936-653-8201
  • Fax: 936-653-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number20867
License Number StateTX

VIII. Authorized Official

Name: JOHN ALSTON
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 936-634-8155