Healthcare Provider Details

I. General information

NPI: 1962439919
Provider Name (Legal Business Name): BROOKSHIRE BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 HWY 150 W
COLDSPRING TX
77331
US

IV. Provider business mailing address

1201 ELLEN TROUT DR
LUFKIN TX
75904-1233
US

V. Phone/Fax

Practice location:
  • Phone: 936-653-3284
  • Fax: 936-653-3286
Mailing address:
  • Phone: 936-634-8155
  • Fax: 936-634-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25661
License Number StateTX

VIII. Authorized Official

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