BROULIM SUPERMARKETS, LLC
NPI 1669935813
Pharmacy - Community/Retail Pharmacy in Saint Anthony, ID

Q: What is Broulim Supermarkets, LLC's NPI number?

The NPI number for Broulim Supermarkets, LLC is 1669935813. It was assigned to this organization in the NPPES registry on April 12, 2019. The provider is doing business as Broulim's Pharmacy #5 -Saint Anthony.

Q: 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.

Active since April 12, 2019

301 ASPEN SQ, SAINT ANTHONY, ID 83445(208) 228-0424(844) 721-6082 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, Jan 29, 2021, Apr 12, 2019 (3 updates tracked since 2019).

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About Broulim Supermarkets, Llc NPPES

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

BROULIM SUPERMARKETS, LLC (NPI 1669935813), doing business as Broulim's Pharmacy #5 -saint Anthony, is a healthcare organization registered as a community/retail pharmacy in Saint Anthony, Idaho and active in the NPI registry since April 2019. The organization lists Marcus C. Hurst, Pharmacy Director, as its authorized official.

NPPES Registry Identity

NPI1669935813

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameBROULIM SUPERMARKETS, LLC

Location Address301 ASPEN SQSaint Anthony, ID 83445-1662

Mailing Address160 S Clark StRigby, ID 83442-1407 · (208) 745-9201 · Fax (208) 745-3431

Phone(208) 228-0424

Fax(844) 721-6082

Organization SubpartNo

Authorized OfficialMarcus C. HurstPharmacy Director · (208) 745-9201

Enumeration DateApril 12, 2019

Last NPPES UpdateJuly 3, 20253 updates tracked since enumeration

NPPES CertifiedJuly 3, 2025

✔ NPI 1669935813 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

301 ASPEN SQ, Saint Anthony, ID 83445

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Other Names 1

Doing Business AsBroulim's Pharmacy #5 -saint Anthony

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.

36 services35 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.

33 services33 patients

Other Providers at the Same Location NPPES

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

DR. JAMES K HUNTER

Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)

301 ASPEN SQ
SAINT ANTHONY, ID 83445

Fremont County (208) 624-3035

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 1669935813. It was assigned to this organization in the NPPES registry on April 12, 2019. The provider is doing business as Broulim's Pharmacy #5 -Saint Anthony.

Where is Broulim Supermarkets, LLC located?

Broulim Supermarkets, LLC is located at 301 Aspen Sq, Saint Anthony, ID 83445. The listed phone number is (208) 228-0424.

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.