BROULIM SUPERMARKETS LLC NPI 1851854095

NPI Details

BROULIM SUPERMARKETS, LLC is a community/retail pharmacy pharmacy in Ammon, ID. 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 1851854095. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

3160 E 17TH ST STE 164
AMMON, ID
ZIP 83406-784
Phone: (208) 529-1795
Fax: (833) 887-9908

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

The CLIA number assigned to this NPI record is 13D2167140 - 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)
• Fee covid-19 vac 14 res (HCPCS:0134A)
• Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
• Adm sarscv2 30mcg trs-sucr b (HCPCS:0054A)
• Influenza vaccine, quadrivalent derived from recombinant dna (HCPCS:90682)
• Administration of pneumococcal vaccine (HCPCS:G0009)

The enumeration date for this NPI number is 4/12/2019 and was last updated on 7/3/2025.

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:

Other Identifiers

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