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Contact Information

BROULIM SUPERMARKETS LLC
89 W 2ND S
SODA SPRINGS, ID83276-1509
 Phone: 208-547-3300
 Fax: 855-847-9646
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Clinic Pharmacy

3336C0002X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for BROULIM SUPERMARKETS LLC

NPI # 1508926734
LBN Legal business name BROULIM SUPERMARKETS LLC
Authorized official MARCUS HURST - (PHARMACY DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/11/2006
Last updated 07/03/2025 - About 11 months ago
Identifiers
ID Medicaid 1508926734
Other 1306162 NCPDP
ID Other 2098RP BOARD OF PHARMACY
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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