MEDICARE: BLOSSOM ODIONG PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18844	CO

General Provider Information

NPI Number	:	1881961084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLOSSOM ODIONG PHARMD

Provider Business Mailing Address
First Line	:	1619 HUMBOLDT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 E COLFAX AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1515
Country	:	US
Telephone Number	:	303-398-6066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	11/16/2011

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Directions to “ BLOSSOM ODIONG PHARMD” Practice Location

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