Organization
BROULIMS 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
130 S 4TH ST, MONTPELIER, ID 83254-1538
(208) 847-0806
(855) 847-9649
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308217
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1750525754
—
ID
01
—
1912011
IMMUNIZATION SUPPLIER NSC
ID
01
—
2322RP
BOARD OF PHARMACY
ID
Enumeration date
04/22/2009
Last updated
07/03/2025
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