| NPI | 1225478894 |
|---|---|
| Other Name | BROULIM'S PHARMACY #4 - THAYNE |
| Entity Type | Organization |
| Authorized Contact | MARCUS C HURST Pharmacy Supervisor 208-745-9201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-09-22 |