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BROULIM SUPERMARKETS LLC
NPI 1508926734
Pharmacy - Community/Retail Pharmacy in Soda Springs, ID

Active since December 11, 2006
89 W 2ND S, SODA SPRINGS, ID 83276(208) 547-3300(855) 847-9646 Get Directions Write a Review

NPPES record last updated: July 3, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 3, 2025, Jan 29, 2021, Jan 17, 2017 and 5 more (8 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 1508926734), doing business as Broulim's Pharmacy #10 - Soda Springs, is a healthcare organization registered as a community/retail pharmacy in Soda Springs, Idaho and active in the NPI registry since December 2006. The organization lists Marcus Hurst, Pharmacy Director, as its authorized official.

NPPES Registry Identity

NPI1508926734
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameBROULIM SUPERMARKETS LLC
Location Address89 W 2ND SSoda Springs, ID 83276-1509
Mailing Address160 S Clark StRigby, ID 83442-1407 · (208) 745-9201 · Fax (208) 745-3431
Phone(208) 547-3300
Fax(855) 847-9646
Organization SubpartNo
Authorized OfficialMarcus HurstPharmacy Director · (208) 745-9201
Enumeration DateDecember 11, 2006
Last NPPES UpdateJuly 3, 20258 updates tracked since enumeration
NPPES CertifiedJuly 3, 2025
✔ NPI 1508926734 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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 ListedPharmacyTaxonomy 333600000X
Also ListedPharmacy · Clinic PharmacyTaxonomy 3336C0002X
89 W 2ND S, Soda Springs, ID 83276
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Other Names 1

Doing Business AsBroulim's Pharmacy #10 - Soda Springs

Other Identifiers 3

Medicaid1508926734ID
Other2098RPID · Board Of Pharmacy
Other1306162Ncpdp

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 2

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.
120 services118 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.
60 services60 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.

MORGAN RAE EVANS PHARMD
Pharmacist
89 W 2ND S
SODA SPRINGS, ID 83276
Caribou County (208) 547-3300
MS. REBECCA LYNNE WEBSTER PHARM.D.
Pharmacist
89 W 2ND S
SODA SPRINGS, ID 83276
Caribou County (208) 547-3300
ROBERT GRAY BIRCH PHARMD
Pharmacist
89 W 2ND S
SODA SPRINGS, ID 83276
Caribou County (208) 547-3300
DR. JEFFREY GRUNDHAUSER PHARMD
Pharmacist
89 W 2ND S
SODA SPRINGS, ID 83276
Caribou County (208) 547-3300

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 1508926734. It was assigned to this organization in the NPPES registry on December 11, 2006. The provider is doing business as Broulim's Pharmacy #10 - Soda Springs.

Where is Broulim Supermarkets LLC located?

Broulim Supermarkets LLC is located at 89 W 2nd S, Soda Springs, ID 83276. The listed phone number is (208) 547-3300.

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 15 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.