Organization
BROULIM SUPERMARKETS, LLC
Active
Other names
Broulims Pharmacy
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
150 N STATE ST, RIGBY, ID 83442-1443
(208) 745-0267
(866) 238-2549
Mailing address
160 S CLARK ST, RIGBY, ID 83442-1407
(208) 745-9201
(208) 745-7433
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1305831
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1720132178
—
ID
01
—
1912011
MEDICARE NORIDIAN
ID
Enumeration date
01/23/2007
Last updated
07/03/2025
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