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	18292	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2104162	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962501288
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	:	936-633-4678

Provider Business Practice Location Address
First Line	:	400 W 2ND ST
Second Line	:
City	:	HEARNE
State	:	TX
Zip	:	77859-2566
Country	:	US
Telephone Number	:	979-279-5343
Fax Number	:	979-279-3374

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	:	02/05/2020

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Directions to “BROOKSHIRE BROTHERS INC ” Practice Location

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