1225646037 NPI number — BROOKSHIRE BROTHERS INC

Table of content: (NPI 1225646037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225646037 NPI number — BROOKSHIRE BROTHERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKSHIRE BROTHERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225646037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 ELLEN TROUT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75904-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-634-8155
Provider Business Mailing Address Fax Number:
936-633-4678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77657-7374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-227-2004
Provider Business Practice Location Address Fax Number:
409-755-0311
Provider Enumeration Date:
07/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ADKISON
Authorized Official First Name:
TONIA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PHARMACY ADMIN
Authorized Official Telephone Number:
936-634-8155

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33327 . This is a "TEXAS STATE BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com