Brookshire Brothers Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

30252 Issued in TX

Legal business name

BROOKSHIRE BROTHERS INC

Doing business as

Brookshire Brothers Pharmacy #79

Practice address

18275 FM 306
Canyon Lake, TX 78133

Phone

(830) 935-3136

Fax

(830) 935-3138

NPI assigned

Oct 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Alston

Title

President Ceo

Phone

(936) 634-8155

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Brookshire Brothers Pharmacy #79 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ellen Gerland, RPH

  • Pharmacist
  • Wimberley, TX
  • NPI 1598351926
  NPD (past)
• Ronny Ray Rozell

  • Pharmacist
  • Canyon Lake, TX
  • NPI 1033713052
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1023480555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 ELLEN TROUT DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759041233",
            "telephone_number": "936-634-8155",
            "fax_number": "936-633-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18275 FM 306",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "78133",
            "telephone_number": "830-935-3136",
            "fax_number": "830-935-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSHIRE BROTHERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-23",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "ALSTON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "936-634-8155"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "30252",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2154777",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "468309",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookshire Brothers Pharmacy #79",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookshire Brothers Pharmacy #79",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Ann Bentley, LPC-A
• Bexarcare Pediatric Home Healthcare
• Blue Water Therapists, PLLC
• Brian Bodkin
• Brandon Grimm D.C. P.a.
• Brian Bumphus, PRSS
• Shawn Burch, LPC
• Eva Callahan
• Danny Lopez Campos, APRN, MSN, FNP-C
• Tammy Cantu, LPC

• Community/Retail Pharmacy in Canyon Lake, TX
• Providers in Canyon Lake, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.