Provider Demographics
NPI:1942309265
Name:BROOKSHIRE BROTHERS INC
Entity Type:Organization
Organization Name:BROOKSHIRE BROTHERS INC
Other - Org Name:BROOKSHIRE BROTHERS PHARMACY
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 1:300 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3404
Mailing Address - Country:US
Mailing Address - Phone:337-786-5863
Mailing Address - Fax:337-786-5872
Practice Address - Street 1:300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3404
Practice Address - Country:US
Practice Address - Phone:337-786-5863
Practice Address - Fax:337-786-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA39623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1265969Medicaid
2033734OtherPK
LA1265969Medicaid
LA1265969Medicaid