Provider Demographics
NPI:1235296682
Name:BROOKSHIRE BROS LTD
Entity Type:Organization
Organization Name:BROOKSHIRE BROS LTD
Other - Org Name:BROOKSHIRE BROS INSTITUTIONAL PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:936-634-8155
Mailing Address - Street 1:1906 N FRAZIER ST
Mailing Address - Street 2:STE B
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1906 N FRAZIER ST
Practice Address - Street 2:STE B
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1240
Practice Address - Country:US
Practice Address - Phone:936-539-6521
Practice Address - Fax:936-539-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX252653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4543573OtherOTHER ID NUMBER-COMMERCIAL NUMBER