Healthcare Provider Details

I. General information

NPI: 1558029108
Provider Name (Legal Business Name): BROOKSHIRE BROTHERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 N ESPLANADE ST
CUERO TX
77954-3433
US

IV. Provider business mailing address

1201 ELLEN TROUT DR
LUFKIN TX
75904-1233
US

V. Phone/Fax

Practice location:
  • Phone: 361-524-4000
  • Fax: 361-275-8285
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 Number
License Number State

VIII. Authorized Official

Name: TONIA LYNN ADKISON
Title or Position: PHARMACY ADMIN
Credential:
Phone: 936-634-8155