Provider Demographics
NPI:1093818106
Name:BROOKSHIRE PHARMACY INC
Entity Type:Organization
Organization Name:BROOKSHIRE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BROOKSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-252-2718
Mailing Address - Street 1:462 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4263
Mailing Address - Country:US
Mailing Address - Phone:828-252-2728
Mailing Address - Fax:828-252-2758
Practice Address - Street 1:462 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-4263
Practice Address - Country:US
Practice Address - Phone:828-252-2718
Practice Address - Fax:828-252-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0115030Medicaid
0789690001Medicare NSC