Organization
BROULIM SUPERMARKETS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS C HURST PHARMD (PHARMACY DIRECTOR)
(208) 745-9201
Entity
Organization
Contact information
Practice address
160 S CLARK ST, RIGBY, ID 83442-1407
(208) 745-9201
(208) 745-3431
Mailing address
160 S CLARK ST, RIGBY, ID 83442-1407
(208) 745-9201
(208) 745-3431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
08/22/2024
Last updated
02/19/2025
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