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General NPI Number Information
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NPI Number | 1962077545
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Entity Type | Organization
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Legal Business Name | BLOSSOM GARDEN BOUTIQUE
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 203 S 26TH ST STE E
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City | ARKADELPHIA
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State | AR
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Zip | 71923-5456
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Country | US
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Telephone | 870-293-1300
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Fax | 702-931-3018
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Provider Business Mailing Address
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Address Line | 104 W 3RD ST
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City | MALVERN
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State | AR
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Zip | 72104-3714
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Country | US
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Telephone | 501-267-7071
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Fax | 501-267-7073
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA EMERSON
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Credential | CFM
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Telephone | 501-815-2482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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