NPIMap

Organization Active NPI

Broulim Supermarkets, LLC

Doing business as Broulim's Pharmacy #5 -Saint Anthony

  • Community/Retail Pharmacy
  • Saint Anthony, ID
National Provider Identifier
1669935813
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BROULIM SUPERMARKETS, LLC
Doing business as
Broulim's Pharmacy #5 -Saint Anthony
Practice address
301 Aspen SQ
Saint Anthony, ID 83445-1662
Phone
(208) 228-0424
Fax
(844) 721-6082
NPI assigned
Apr 12, 2019
Last updated
Jul 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marcus C. Hurst, PHARMDNPI 1447666128
Title
Pharmacy Director
Phone
(208) 745-9201

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

301 Aspen SQ
Saint Anthony, ID 83445-1662

Mailing address

160 S Clark St
Rigby, ID 83442-1407
Phone (208) 745-9201

Other names 1

  • Broulim's Pharmacy #5 -Saint Anthony Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2167279Broulim's Pharmacy #5301 Aspen Square, Saint Anthony, ID 83445Certificate of waiverJun 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Broulim Supermarkets LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 Aspen Sq
Saint Anthony, ID 83445
Phone (208) 228-0424

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1669935813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 S CLARK ST",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834421407",
            "telephone_number": "208-745-9201",
            "fax_number": "208-745-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ASPEN SQ",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834451662",
            "telephone_number": "208-228-0424",
            "fax_number": "844-721-6082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROULIM SUPERMARKETS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-12",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "HURST",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "208-745-9201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broulim's Pharmacy #5 -Saint Anthony",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Anthony, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.