Active NPI
Brookshire Brothers Inc
- Community/Retail Pharmacy
- Groveton, TX
National Provider Identifier
1386744720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 18313
- Legal business name
- BROOKSHIRE BROTHERS INC
- Practice address
- 520 W First St
Groveton, TX 75845-4175 - Phone
- (936) 642-1174
- Fax
- (936) 642-0011
- NPI assigned
- Sep 25, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Alston
- Title
- Vice President of Retail
- Phone
- (936) 634-8155
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 18313 | TX | Primary |
Addresses
Primary practice location
520 W First St
Groveton, TX 75845-4175
Mailing address
1201 Ellen Trout Dr
Lufkin, TX 75904-1233
Phone (936) 634-8155
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2106482 | Other | PK | |
| 464111 | Medicaid | TX | |
| 4598821 | Medicaid | TX |
Other names 1
- Brookshire Brothers Pharmacy #62
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080320000508 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 0143221085 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1580860800000",
"number": "1386744720",
"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": "936-634-8646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 W FIRST ST",
"city": "GROVETON",
"state": "TX",
"postal_code": "758454175",
"telephone_number": "936-642-1174",
"fax_number": "936-642-0011"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOKSHIRE BROTHERS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2020-02-05",
"certification_date": "2020-02-05",
"status": "A",
"authorized_official_last_name": "ALSTON",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "VICE PRESIDENT OF RETAIL",
"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": "18313",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2106482",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "464111",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4598821",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Brookshire Brothers Pharmacy #62",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Groveton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.