Provider Demographics
NPI:1114026432
Name:BROOKSHIRE BROTHERS INC
Entity Type:Organization
Organization Name:BROOKSHIRE BROTHERS INC
Other - Org Name:BROOKSHIRE BROTHERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-8155
Mailing Address - Street 1:14100 RANCH ROAD 12
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5354
Mailing Address - Country:US
Mailing Address - Phone:512-847-7520
Mailing Address - Fax:512-842-8032
Practice Address - Street 1:14100 RANCH ROAD 12
Practice Address - Street 2:SUITE 2A
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5354
Practice Address - Country:US
Practice Address - Phone:512-847-7520
Practice Address - Fax:512-842-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX195493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX464302Medicaid
2092113OtherPK
0854980056Medicare NSC
4508771OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TXPH0626Medicare PIN