Broulim Supermarkets, LLC
Organization Active NPI Community/Retail Pharmacy · Rigby, ID
NPI 1720132178 · NPPES record last updated Jul 3, 2025
Key facts
- NPI
- 1720132178
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BROULIM SUPERMARKETS, LLC
- Practice address
- 150 N State St
Rigby, ID 83442-1443 - Phone
- (208) 745-0267
- Fax
- (866) 238-2549
- NPI assigned
- Jan 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Marcus C Hurst, PHARMD
- Title
- Pharmacy Director
- Phone
- (208) 745-9201
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D2135566 | Broulims Pharmacy #1 | Certificate of waiver | Aug 22, 2027 |
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 Practice locations: Rigby, ID; Soda Springs, ID; Shelley, ID; Saint Anthony, ID; Rexburg, ID; Idaho Falls, ID; Driggs, ID; Ammon, ID… |
National Provider Directory
Locations
150 N State St
Rigby, ID 83442
Phone (208) 745-0267
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | |||
| Clinic Pharmacy | 3336C0002X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
150 N State St
Rigby, ID 83442-1443
Mailing address
160 S Clark St
Rigby, ID 83442-1407
Phone (208) 745-9201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1305831 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| 1912011 | Other | ID | MEDICARE NORIDIAN |
| 1720132178 | Medicaid | ID |
Other names
- Broulims Pharmacy
Other providers in Rigby, ID
- Emily Bowcutt
- Laurie Ann Bowcutt
- Brian J. Decker, MSN, FNPC, PC
- Brightside Dental PLLC
- Broulim Supermarkets, LLC
- Nathaniel Brown
- Seth Joseph Buck
- Devri Burnell
- Garrett Brent Burton
- Riley Burton
All providers in Rigby, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.