Broulims Pharmacy

LBN: Broulim Supermarkets Llc
Broulims Pharmacy is an health care organization with primary practice located at 124 W Main St , Rexburg ID 83440-1827. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Broulim Supermarkets Llc can be contacted via phone (208) 356-5416, or through Hurst, Marcus via phone (208) 745-9201.

Contact Information

Primary practice address
124 W Main St Rexburg ID 83440-1827
Phone: (208) 356-5416
Fax: (208) 356-5653
Website:
Map and Directions
Authorized official contact:
Name: Hurst, Marcus PHARMD
Phone: (208) 745-9201

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 1280RP Idaho

Profile Details

NPI number 1003969346
LBN Legal business name Broulim Supermarkets Llc
DBA Doing business as Broulims Pharmacy
Authorized official Hurst, Marcus PHARMD
Entity Organization
Organization subpart 1 No
Enumeration date Jan 19th, 2007
Last updated Sep 7th, 2022 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003969346 NPPES
Idaho MEDICAID 1003969346
Idaho Other 2129024

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