Broulim Supermarkets LLC
Organization Active NPI Community/Retail Pharmacy · Soda Springs, ID
NPI 1508926734 · NPPES record last updated Jul 3, 2025
Key facts
- NPI
- 1508926734
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BROULIM SUPERMARKETS LLC
- Practice address
- 89 W 2ND S
Soda Springs, ID 83276-1509 - Phone
- (208) 547-3300
- Fax
- (855) 847-9646
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Marcus Hurst, PHARMD
- Title
- Pharmacy Director
- Phone
- (208) 745-9201
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 11
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110928000334 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 5890966691 |
9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rigby, ID; Soda Springs, ID; Shelley, ID; Saint Anthony, ID; Rexburg, ID; Idaho Falls, ID; Driggs, ID; Ammon, ID… |
National Provider Directory
- Tax ID family
- Broulim Supermarkets LLC
Locations
89 W 2nd S
Soda Springs, ID 83276
Phone (208) 547-3300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Clinic Pharmacy | 3336C0002X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
89 W 2ND S
Soda Springs, ID 83276-1509
Mailing address
160 S Clark St
Rigby, ID 83442-1407
Phone (208) 745-9201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508926734 | Medicaid | ID | |
| 2098RP | Other | ID | BOARD OF PHARMACY |
| 1306162 | Other | NCPDP |
Other names
- Broulim's Pharmacy #10 - Soda Springs
Other providers in Soda Springs, ID
- Robert Gray Birch
- Bowman Chiropractic
- Bowman Chiropractic PLLC
- Eric Bowman
- Wesley Aaron Bowman
- Sara Brown
- Caribou County
- Caribou Medical Center, Inc
- Caribou Medical Center, Inc
- Caribou Medical Center, Inc
All providers in Soda Springs, ID · Community/Retail Pharmacy in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.