Organization
BROULIM SUPERMARKETS, LLC
Active
Other names
Broulim's Pharmacy #12 - Afton
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS HURST PHARMD (PHARMACY DIRECTOR)
(208) 745-9201
Entity
Organization
Contact information
Practice address
141 N WASHINGTON ST, AFTON, WY 83110
(307) 885-5055
(855) 841-5350
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
—
5204463
NCPDP
—
01
—
R10090
BOARD OF PHARMACY
WY
05
—
WY0157
—
WY
Enumeration date
11/26/2012
Last updated
07/03/2025
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