1. Home
  2. Directory
  3. Idaho
  4. Shelley
  5. Pharmacy
  6. NPI Profile

BROULIM SUPERMARKETS, LLC
NPI 1396870911
Pharmacy - Community/Retail Pharmacy in Shelley, ID

Active since February 22, 2007
570 S STATE ST, SHELLEY, ID 83274(208) 357-0473(844) 721-6089 Get Directions Write a Review

NPPES record last updated: July 3, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 3, 2025, Nov 19, 2024, Jan 29, 2021 and 4 more (7 updates tracked since 2016).

About Broulim Supermarkets, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROULIM SUPERMARKETS, LLC (NPI 1396870911), doing business as Broulim's Pharmacy #9 - Shelley, is a healthcare organization registered as a community/retail pharmacy in Shelley, Idaho and active in the NPI registry since February 2007. The organization lists Marcus C Hurst, Pharmacy Director, as its authorized official.

NPPES Registry Identity

NPI1396870911
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameBROULIM SUPERMARKETS, LLC
Location Address570 S STATE STShelley, ID 83274-1470
Mailing Address160 S Clark StRigby, ID 83442-1407 · (208) 745-9201 · Fax (208) 745-7433
Phone(208) 357-0473
Fax(844) 721-6089
Organization SubpartNo
Authorized OfficialMarcus C HurstPharmacy Director · (208) 745-9201
Enumeration DateFebruary 22, 2007
Last NPPES UpdateJuly 3, 20257 updates tracked since enumeration
NPPES CertifiedJuly 3, 2025
✔ NPI 1396870911 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
Definition
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.
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
Also ListedPharmacyTaxonomy 333600000X
Also ListedPharmacy · Clinic PharmacyTaxonomy 3336C0002X
570 S STATE ST, Shelley, ID 83274
Open in Google Maps ↗

Other Names 1

Doing Business AsBroulim's Pharmacy #9 - Shelley

Other Identifiers 3

Other1876RPID · Board Of Pharmacy
Medicaid1396870911ID
Other1307493Ncpdp

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Broulim Supermarkets, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateIdahoEnrollment IDO20110928000334Non-DME Part B · Mass Immunization (Roster Biller Only)Due dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
61 services61 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
50 services50 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
11 services11 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
11 services11 patients

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NATHAN BOLANDER
Pharmacist
570 S STATE ST
SHELLEY, ID 83274
Bingham County (208) 357-0473
TIMOTHY ELRAY ALLEN PHARM D
Pharmacist
570 S STATE ST
SHELLEY, ID 83274
Bingham County (208) 357-0473
DR. DANIEL SCHAUWECKER PHARMD
Pharmacist
570 S STATE ST
SHELLEY, ID 83274
Bingham County (208) 357-0495
BLAINE L WILDING PHARMD
Pharmacist
570 S STATE ST
SHELLEY, ID 83274
Bingham County (208) 357-0473

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Broulim Supermarkets, LLC's NPI number?

The NPI number for Broulim Supermarkets, LLC is 1396870911. It was assigned to this organization in the NPPES registry on February 22, 2007. The provider is doing business as Broulim's Pharmacy #9 - Shelley.

Where is Broulim Supermarkets, LLC located?

Broulim Supermarkets, LLC is located at 570 S State St, Shelley, ID 83274. The listed phone number is (208) 357-0473.

What is Broulim Supermarkets, LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Is Broulim Supermarkets, LLC enrolled in Medicare?

Yes. Broulim Supermarkets, LLC is registered in the Medicare PECOS enrollment system.

When is Broulim Supermarkets, LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Idaho, Mass Immunization (Roster Biller Only)) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

What insurance does Broulim Supermarkets, LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 46 other insurers list Broulim Supermarkets, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Broulim Supermarkets, LLC was last updated on July 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.