# BLOSSOM PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710363114
- **Authorized official:** BENJAMIN U EMAREYO (PHARMACY MANAGER)
- **Authorized official phone:** (678) 217-5645

## Contact information

- **Practice address:** 5780 C H JAMES PKWY STE 230, POWDER SPRINGS, GA 30127-6077
- **Practice address phone:** (678) 217-5645
- **Practice address fax:** (844) 269-6494
- **Mailing address:** 5780 C H JAMES PKWY STE 230, POWDER SPRINGS, GA 30127-6077
- **Mailing address phone:** (617) 922-7069
- **Mailing address fax:** (678) 503-2203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE010164 | GA | Yes |

## Other

- **Enumeration date:** 08/07/2015
- **Last updated:** 03/16/2024