Broulim Supermarkets, LLC
Pharmacy, Community/Retail Pharmacy in Saint Anthony, ID. Organization (NPI-2).
NPI number1669935813
StatusActive
Last updated in NPPESJul 3, 2025
Details
- NPI
- 1669935813
- Entity type
- Organization (NPI-2)
- Legal business name
- Broulim Supermarkets, LLC
- Organization subpart
- No
- Enumeration date
- Apr 12, 2019
- Certification date
- Jul 3, 2025
- Last updated
- Jul 3, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 333600000X | Pharmacy | – | – | |
| 3336C0002X | Pharmacy, Clinic Pharmacy | – | – |
Other names
- Broulim'S Pharmacy #5 -Saint Anthony (Doing Business As)
Practice location
301 Aspen SqSaint Anthony, ID 83445-1662
Phone 208-228-0424 · Fax 844-721-6082
Mailing address
160 S Clark StRigby, ID 83442-1407
Phone 208-745-9201 · Fax 208-745-3431
Authorized official
Marcus C. Hurst
Pharmacy Director
2087459201
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