Provider Demographics
NPI:1578163242
Name:BROOKSHIRE, MICHELLE MONIQUE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MONIQUE
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-8185
Mailing Address - Country:US
Mailing Address - Phone:956-212-8975
Mailing Address - Fax:
Practice Address - Street 1:215 E 3 MILE ROAD
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78574
Practice Address - Country:US
Practice Address - Phone:956-519-2240
Practice Address - Fax:956-519-2746
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist