Provider Type Icon

BROULIM SUPERMARKETS LLC NPI 1659615078


NPI Information

NPI: 1659615078
Provider Name: BROULIM SUPERMARKETS, LLC

Doing Business As: BROULIMS PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 53D2141014

Address:
141 N WASHINGTON ST
AFTON, WY
ZIP 83110
Phone: (307) 886-5550
Get Directions

BROULIM SUPERMARKETS, LLC is a community/retail pharmacy pharmacy in Afton, WY. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. BROULIM SUPERMARKETS, LLC NPI is 1659615078. The provider is registered as an organization entity type.
The provider Is Doing Business As Broulims Pharmacy.

The provider's business location address is:

141 N WASHINGTON ST
AFTON, WY
ZIP 83110
Phone: (307) 886-5550
Fax: (307) 885-5057

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 53D2141014 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/26/2012 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail PharmacyR10090WYOMINGYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1W25566OTHERWYOMINGIMMUNIZATION SUPPLIER NSC
2WY0157MEDICAIDWYOMING
35204463OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.