Organization
BLOSSOM CARE PHARMACY LLC
Active
Organization
BLOSSOM CARE PHARMACY LLC
Active
Other names
BLOSSOM CARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
IMANE ALZAROUI RPH (OWNER, PIC, AO)
(313) 377-0793
Entity
Organization
Contact information
Practice address
5250 AUTO CLUB DR STE 160, DEARBORN, MI 48126-2619
(313) 436-5513
(313) 436-5405
Mailing address
5250 AUTO CLUB DR STE 160, DEARBORN, MI 48126-2619
(313) 436-5513
(313) 436-5405
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010768
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155809
PK
—
05
—
2381363
—
MI
Enumeration date
12/07/2015
Last updated
01/20/2017
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