Healthcare Provider Details

I. General information

NPI: 1588763809
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: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W FRANK AVE
LUFKIN TX
75904-5108
US

IV. Provider business mailing address

1201 ELLEN TROUT DR
LUFKIN TX
75904-1233
US

V. Phone/Fax

Practice location:
  • Phone: 936-634-8394
  • Fax: 936-634-4068
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 Number20818
License Number StateTX

VIII. Authorized Official

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