MEDICARE: BROOKSHIRE BROTHERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	19549	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2092113	OTHER		PK

General Provider Information

NPI Number	:	1114026432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSHIRE BROTHERS INC

Provider Business Mailing Address
First Line	:	14100 RANCH ROAD 12
Second Line	:	SUITE 2A
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-5354
Country	:	US
Telephone Number	:	512-847-7520
Fax Number	:	512-842-8032

Provider Business Practice Location Address
First Line	:	14100 RANCH ROAD 12
Second Line	:	SUITE 2A
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-5354
Country	:	US
Telephone Number	:	512-847-7520
Fax Number	:	512-842-8032

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	JOHN ALSTON
Credential	:
Telephone Number	:	936-634-8155

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/11/2015

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Directions to “BROOKSHIRE BROTHERS INC ” Practice Location

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