Provider Demographics
NPI:1558029108
Name:BROOKSHIRE BROTHERS INC
Entity Type:Organization
Organization Name:BROOKSHIRE BROTHERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ADKISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-634-8155
Mailing Address - Street 1:1201 ELLEN TROUT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-1233
Mailing Address - Country:US
Mailing Address - Phone:936-634-8155
Mailing Address - Fax:936-633-4678
Practice Address - Street 1:1161 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-3433
Practice Address - Country:US
Practice Address - Phone:361-524-4000
Practice Address - Fax:361-275-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34065OtherTSBP