Provider Demographics
NPI:1114032158
Name:BROOKSHIRE PHARMACY INC
Entity Type:Organization
Organization Name:BROOKSHIRE PHARMACY INC
Other - Org Name:UNION DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-562-5441
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OR
Mailing Address - Zip Code:97883-0400
Mailing Address - Country:US
Mailing Address - Phone:541-562-5441
Mailing Address - Fax:541-562-5269
Practice Address - Street 1:105 N MAIN
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OR
Practice Address - Zip Code:97883-0400
Practice Address - Country:US
Practice Address - Phone:541-562-5441
Practice Address - Fax:541-562-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ORRP-00005753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125216Medicaid
2077558OtherPK