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	3336C0003X	Community/Retail Pharmacy	25661	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2096659	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962439919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSHIRE BROTHERS INC

Provider Business Mailing Address
First Line	:	1201 ELLEN TROUT DR
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75904-1233
Country	:	US
Telephone Number	:	936-634-8155
Fax Number	:	936-634-8646

Provider Business Practice Location Address
First Line	:	15100 HWY 150 W
Second Line	:
City	:	COLDSPRING
State	:	TX
Zip	:	77331
Country	:	US
Telephone Number	:	936-653-3284
Fax Number	:	936-653-3286

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/06/2015

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Directions to “BROOKSHIRE BROTHERS INC ” Practice Location

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