Organization
BROULIM SUPERMARKETS, LLC
Active
Other names
Broulim's Pharmacy #8 - Ammon
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
2730 E SUNNYSIDE RD, AMMON, ID 83406-7547
(208) 522-3257
(855) 829-8681
Mailing address
160 S CLARK ST, RIGBY, ID 83442-1407
(208) 745-9201
(208) 745-3431
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1309310
NCPDP
—
05
—
1336517861
—
ID
01
—
40088RP
BOARD OF PHARMACY
ID
Enumeration date
09/15/2015
Last updated
07/03/2025
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