Broulim Supermarkets, LLC
Broulim Supermarkets, LLC is a healthcare organization registered as Community/Retail Pharmacy in Rexburg, ID, holding Type 2 (organization) NPI 1003969346 since 2007. The authorized official on file is Marcus Hurst, Pharmacy Director.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1003969346 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Broulim Supermarkets, LLC |
| Other name | <Unavail> |
| Practice address | 124 W MAIN ST, Rexburg, ID, 83440 |
| Phone | 2083565416 |
| Fax | 8662385784 |
| Enumeration date | 2007-01-19 |
| Last updated in NPPES | 2025-07-03 |
Authorized official
| Name | Marcus Hurst |
|---|---|
| Title | Pharmacy Director |
| Phone | 2087459201 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0002X | Clinic Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003969346 | Medicaid | ID | — |
| 1280RP | Other | ID | BOARD OF PHARMACY |
Copy-ready billing details
Provider: Broulim Supermarkets, LLC NPI: 1003969346 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 124 W MAIN ST, Rexburg, ID, 83440
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1457636482 | Stephen Moss | Individual | Pharmacist | Rexburg, ID |
| 1821601923 | Christopher Smith | Individual | Pharmacist | Rexburg, ID |
Verify this record
Cross-check NPI 1003969346 against the authoritative CMS record: view Broulim Supermarkets, LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Broulim Supermarkets, LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-07-03.