Provider Demographics
NPI:1346226875
Name:BROOKSHIRE BROS PHARMACY OF KIRBYVILLE TEXAS
Entity Type:Organization
Organization Name:BROOKSHIRE BROS PHARMACY OF KIRBYVILLE TEXAS
Other - Org Name:BROOKSHIRE BROTHERS PHARMACY OF KIRBYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-893-0677
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2407
Mailing Address - Country:US
Mailing Address - Phone:903-893-0677
Mailing Address - Fax:
Practice Address - Street 1:1005 S MARGARET AVE
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956-2422
Practice Address - Country:US
Practice Address - Phone:409-423-2248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14614332B00000X, 333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143743Medicaid
TX0168395-01Medicaid
TXPH0442OtherMEDICARE FLU
TX1262540001Medicare NSC