BROULIM SUPERMARKETS LLC NPI 1487117636

NPI Information

  • NPI: 1487117636
  • Provider Name: BROULIM SUPERMARKETS, LLC
  • Classification: Pharmacy - 333600000X
  • Entity Type: Organization
  • CLIA Number: 13D2167139
  • Address: 1855 W BROADWAY ST
    IDAHO FALLS, ID
    ZIP 83402
  • Phone: (208) 529-3638

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NPI Details

BROULIM SUPERMARKETS, LLC is a pharmacy in Idaho Falls, ID. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. BROULIM SUPERMARKETS, LLC NPI is 1487117636. The provider is registered as an organization entity type.

The provider's business location address is:

1855 W BROADWAY ST
IDAHO FALLS, ID
ZIP 83402-043
Phone: (208) 529-3638
Fax: (208) 523-0222

The provider's authorized official is Marcus C. Hurst .
The authorized official title is Pharmacy Supervisor and has the following contact phone number (208) 745-9201.

The CLIA number assigned to this NPI record is 13D2167139 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)
  • Fee covid-19 vac 13 res (HCPCS:0124A)
  • Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
  • Fee covid-19 vac 14 res (HCPCS:0134A)
  • Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)
  • Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (HCPCS:90686)
  • Administration of pneumococcal vaccine (HCPCS:G0009)

The enumeration date for this NPI number is 4/12/2019 and was last updated on 1/29/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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