=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912007352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOKSHIRE BROTHERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 08/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20185 US HIGHWAY 59 69
-----------------------------------------------------
City | NEW CANEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77357-8358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-689-3936
-----------------------------------------------------
Fax | 281-689-3912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 ELLEN TROUT DR
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75904-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-634-8155
-----------------------------------------------------
Fax | 936-634-8646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATIONS OFFICER
-----------------------------------------------------
Name | JOHN ALSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-634-8155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 18333
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------