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General NPI Number Information
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NPI Number | 1710363114
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Entity Type | Organization
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Legal Business Name | BLOSSOM PHARMACY LLC
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 03/16/2024
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Provider Practice Location Address
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Address Line | 5780 C H JAMES PKWY STE 230
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6077
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Country | US
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Telephone | 678-217-5645
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Fax | 844-269-6494
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Provider Business Mailing Address
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Address Line | 5780 C H JAMES PKWY STE 230
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6077
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Country | US
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Telephone | 617-922-7069
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Fax | 678-503-2203
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | BENJAMIN U EMAREYO
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Credential |
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Telephone | 678-217-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010164
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License Number State | GA
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