Active NPI
Brookshire Brothers LTD
- Long Term Care Pharmacy
- Lufkin, TX
National Provider Identifier
1730289182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- 21990
- Legal business name
- BROOKSHIRE BROTHERS LTD
- Practice address
- 1807 W Frank Ave
Suite B
Lufkin, TX 75904-3185 - Phone
- (936) 634-3285
- Fax
- (936) 634-8218
- 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
- Rayburn Mitchum, BS
- Title
- Pharmacy Administrator
- Phone
- (936) 634-8155
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | 21990 | TX | Primary |
Addresses
Primary practice location
1807 W Frank Ave
Suite B
Lufkin, TX 75904-3185
Mailing address
1807 W Frank Ave
Suite B
Lufkin, TX 75904-3185
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4525260 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 350177 | Medicaid | TX | |
| 4525260 | Other | NCPDP |
Other names 1
- BROOKSHIRE BROTHERS PHARMACY
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": "1184803200000",
"number": "1730289182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 W FRANK AVE",
"address_2": "SUITE B",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1807 W FRANK AVE",
"address_2": "SUITE B",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043185",
"telephone_number": "936-634-3285",
"fax_number": "936-634-8218"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOKSHIRE BROTHERS LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-19",
"status": "A",
"authorized_official_last_name": "MITCHUM",
"authorized_official_first_name": "RAYBURN",
"authorized_official_title_or_position": "PHARMACY ADMINISTRATOR",
"authorized_official_telephone_number": "936-634-8155",
"authorized_official_credential": "BS"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "TX",
"license": "21990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "4525260",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "350177",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "4525260",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "BROOKSHIRE BROTHERS PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; 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.