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General NPI Number Information
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NPI Number | 1730289182
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Entity Type | Organization
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Legal Business Name | BROOKSHIRE BROTHERS LTD
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1807 W FRANK AVE SUITE B
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City | LUFKIN
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State | TX
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Zip | 75904-3185
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Country | US
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Telephone | 936-634-3285
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Fax | 936-634-8218
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Provider Business Mailing Address
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Address Line | 1807 W FRANK AVE SUITE B
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City | LUFKIN
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State | TX
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Zip | 75904-3185
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY ADMINISTRATOR
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Name | RAYBURN MITCHUM
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Credential | BS
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Telephone | 936-634-8155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 21990
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License Number State | TX
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