Organization
BROULIM SUPERMARKETS, LLC
Active
Organization
BROULIM SUPERMARKETS, LLC
Active
Other names
Broulim's Pharmacy #4 - Thayne
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS C HURST PHARMD (PHARMACY DIRECTOR)
(208) 745-9201
Entity
Organization
Contact information
Practice address
118 PETERSEN PKWY, THAYNE, WY 83127
(307) 883-6337
(844) 204-2988
Mailing address
160 S CLARK ST., RIGBY, ID 83442-1407
(307) 883-6337
(208) 883-6338
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R10216
WYOMING BOARD OF PHARMACY
WY
Enumeration date
06/27/2013
Last updated
07/03/2025
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