BROULIM SUPERMARKETS, LLC (NPI# 1396870911) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396870911 |
| Entity Type | Organization |
| Organization Name | BROULIM SUPERMARKETS, LLC |
| Other Organization Name | BROULIMS PHARMACY |
| Practice Address |
570 S State St Shelley ID 83274-1470 |
| Mailing Address |
182 N State St Rigby ID 83442-1444 |
| Practice Telephone | 2083570473 |
| Practice Fax Number | 2083570498 |
| Mailing Telephone | 2087459201 |
| Mailing Fax Number | 2087457433 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2016-05-16 |
| Authorized Official Name | MARCUS C HURST (PHARMACY SUPERVISOR) |
| Authorized Official Telephone | 2087459201 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
1876RP | ID | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1396870911 | 05 | |
| ID | IMMUNIZATION SUPPLIER NSC | 1912011 | 01 |
| NCPDP | 1307493 | 01 |
| Other Name | Type Code |
|---|---|
| Broulims Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669935813 | Broulim Supermarkets, LLC | Pharmacy | 301 Aspen Sq, Saint Anthony, ID 83445-1662 | 2019-04-12 |
| 1720132178 | Broulim Supermarkets, LLC | Pharmacy | 150 N State St, Rigby, ID 83442-1443 | 2007-01-23 |
| 1487117636 | Broulim Supermarkets, LLC | Pharmacy | 1855 W Broadway St, Idaho Falls, ID 83402-3043 | 2019-04-12 |
| 1851854095 | Broulim Supermarkets, LLC | Pharmacy | 3160 E 17th St Ste 164, Ammon, ID 83406-6784 | 2019-04-12 |
| 1336517861 | Broulim Supermarkets, LLC | Pharmacy | 2730 E Sunnyside Rd, Ammon, ID 83406-7547 | 2015-09-15 |
| 1659615078 | Broulim Supermarkets, LLC | Pharmacy | 141 N Washington St, Afton, WY 83110 | 2012-11-26 |
| 1427101674 | Broulim Supermarkets, LLC | Pharmacy | 240 S Main St, Driggs, ID 83422-5401 | 2007-01-19 |
| Street Address |
570 S STATE ST |
| City | SHELLEY |
| State | ID |
| Zip Code | 83274-1470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669854931 | Nathan Bolander | Pharmacist | 570 S State St, Shelley, ID 83274-1470 | 2015-06-23 |
| 1790032548 | Timothy Elray Allen | Pharmacist | 570 S State St, Shelley, ID 83274-1470 | 2012-08-11 |
| 1942579404 | Blaine L Wilding | Pharmacist | 570 S State St, Shelley, ID 83274-1470 | 2011-12-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457976045 | Tyson Hanson | Respite Care | 1496 N 1070 E, Sheley, ID 83274 | 2020-06-10 |
| 1760631949 | Curtis W Carpenter | Dentist | 295 Anderson Rd, Shelley, ID 83274 | 2008-09-12 |
| 1093908741 | Helmsman Services LLC | Community/Behavioral Health | 175 W. Pine St, Shelley, ID 83274 | 2007-08-24 |
| 1871620906 | John R Stohl | Dentist | 530 S State St, Shelley, ID 83274 | 2007-02-27 |
| 1366542391 | Blackfoot Medical Clinic, Inc | Family Medicine | 210 S Emerson St, Shelley, ID 83274 | 2006-09-22 |
| 1174775902 | Shelley Dental, Inc | Dentist | 530 S State St, Shelley, ID 83274 | 2008-10-10 |
| 1043724990 | Randall Searle | Chiropractor | 120 N Emerson Ave, Shelley, ID 83274-1105 | 2017-11-29 |
| 1215437751 | Elevated Life Family Chiropractic Pllc | Chiropractor | 120 N Emerson Ave, Shelley, ID 83274-1105 | 2018-02-20 |
| 1780784769 | Parkway Eyecare PC | Optometrist | 524 N State St, Shelley, ID 83274-1154 | 2006-09-22 |
| 1962436253 | Travis R Wilkins | Chiropractor | 528 N State St, Shelley, ID 83274-1154 | 2006-07-10 |
| Find all providers in zip 83274 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295336709 | Family Health Services Pharmacy | Pharmacy | 218 W. Nez Perce, Jerome, ID 83338 | 2020-11-03 |
| 1841806494 | Deblaquiere Enterprises, Inc. | Pharmacy | 86 Tank Rd, Oldtown, ID 83822-5126 | 2020-09-18 |
| 1043838584 | Costco Wholesale Corporation | Pharmacy | 3403 W Chinden Blvd, Meridian, ID 83646-7151 | 2020-07-10 |
| 1265054324 | Costco Wholesale Corporation | Pharmacy | 2495 E Lincoln Rd, Idaho Falls, ID 83401-2203 | 2020-05-12 |
| 1851923544 | Rocky Mountain Pharmacy, LLC | Pharmacy | 3910 Washington Pkwy Ste A, Idaho Falls, ID 83404-7884 | 2020-02-10 |
| 1013559269 | Timberline Pharmacy | Pharmacy | 4574 N Ten Mile Rd Ste 110, Meridian, ID 83646-6930 | 2019-10-09 |
| 1508420373 | K2red LLC | Pharmacy | 447 N Idaho St, Wendell, ID 83355 | 2019-04-27 |
| 1679039135 | Hollis Family Pharmacy LLC | Pharmacy | 845 S Substation Rd, Emmett, ID 83617 | 2019-02-20 |
| 1598229809 | Clearwater Canyon Pharmacy, LLC | Pharmacy | 13020 Us-12, Orofino, ID 83544 | 2019-01-31 |
| 1861999377 | Bi-mart Corporation | Pharmacy | 11347 W State Street, Star, ID 83669 | 2018-04-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.