Provider Demographics
NPI:1124392899
Name:BROOKSHIRE BROTHERS INC
Entity Type:Organization
Organization Name:BROOKSHIRE BROTHERS INC
Other - Org Name:BROOKSHIRE BROTHERS PHARMACY #75
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:NORMANGEE
Mailing Address - State:TX
Mailing Address - Zip Code:77871-0100
Mailing Address - Country:US
Mailing Address - Phone:936-396-1412
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMANGEE
Practice Address - State:TX
Practice Address - Zip Code:77871
Practice Address - Country:US
Practice Address - Phone:936-396-1412
Practice Address - Fax:936-396-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133932OtherPK