| Broulim Supermarkets, Llc | |
|
570 S State St Shelley ID 83274-1470 | |
| (208) 357-0473 | |
| (844) 721-6089 |
| Full Name | Broulim Supermarkets, Llc |
|---|---|
| Speciality | Pharmacy - Community/retail Pharmacy |
| Location | 570 S State St, Shelley, Idaho |
| Authorized Official Name and Position | Marcus C Hurst (PHARMACY DIRECTOR) |
| Authorized Official Contact | 2087459201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broulim Supermarkets, Llc 160 S Clark St Rigby ID 83442-1407 Ph: (208) 745-9201 | Broulim Supermarkets, Llc 570 S State St Shelley ID 83274-1470 Ph: (208) 357-0473 |
| NPI Number | 1396870911 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 07/03/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396870911 | NPI | - | NPPES |
| 1876RP | Other | ID | BOARD OF PHARMACY |
| 1396870911 | Medicaid | ID | |
| 1307493 | Other | NCPDP |
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