13D2135566 CLIA NUMBER - BROULIMS PHARMACY #1

Laboratory Demographics

  • CLIA Code: 13D2135566
  • Facility Name: BROULIMS PHARMACY #1
  • Facility Address: 150 NORTH STATE STREET
    RIGBY, ID
    ZIP 83442
  • Facility Phone: 208 745-0267
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARCUS C. HURST
  • NPI Number: 1720132178
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2135566
LAB Type Pharmacy
Facility Name BROULIMS PHARMACY #1
Street 150 NORTH STATE STREET
City RIGBY
State ID
ZIP 83442
Phone 208 745-0267
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Pharmacy
Lab Director MARCUS C. HURST

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This page was last updated on: 9/29/2025