Organization
BROULIM SUPERMARKETS LLC
Active
Other names
Broulim's Pharmacy #10 - Soda Springs
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS HURST PHARMD (PHARMACY DIRECTOR)
(208) 745-9201
Entity
Organization
Contact information
Practice address
89 W 2ND S, SODA SPRINGS, ID 83276-1509
(208) 547-3300
(855) 847-9646
Mailing address
160 S CLARK ST, RIGBY, ID 83442-1407
(208) 745-9201
(208) 745-3431
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306162
NCPDP
—
05
—
1508926734
—
ID
01
—
2098RP
BOARD OF PHARMACY
ID
Enumeration date
12/11/2006
Last updated
07/03/2025
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