Healthcare Provider Details

I. General information

NPI: 1134228455
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: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W COLUMBIA ST
SAN AUGUSTINE TX
75972-1710
US

IV. Provider business mailing address

1201 ELLEN TROUT DR
LUFKIN TX
75904-1233
US

V. Phone/Fax

Practice location:
  • Phone: 936-275-9060
  • Fax: 936-275-5202
Mailing address:
  • Phone: 936-634-8155
  • Fax: 936-633-4678

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 Number18302
License Number StateTX

VIII. Authorized Official

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