Active NPI
Benjamin Emareyo
- Pharmacist
- Hiram, GA
National Provider Identifier
1124566534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH025763
- Practice address
- 4109 Jimmy Lee Smith Pkwy Ste C
Hiram, GA 30141-2643 - Phone
- (678) 217-5645
- Fax
- (844) 269-6494
- NPI assigned
- Feb 6, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH025763 | GA | Primary |
Addresses
Primary practice location
4109 Jimmy Lee Smith Pkwy Ste C
Hiram, GA 30141-2643
Mailing address
4109 Jimmy Lee Smith Pkwy Ste C
Hiram, GA 30141-2643
Phone (678) 217-5645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH025763 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blossom Pharmacy LLC | Current | Accepting new patients |
Locations
4109 Jimmy Lee Smith Pkwy
Ste C
Hiram, GA 30141
Phone (678) 217-5645
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Powder Springs, GA
- NPI 1710363114
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1124566534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4109 JIMMY LEE SMITH PKWY STE C",
"city": "HIRAM",
"state": "GA",
"postal_code": "301412643",
"telephone_number": "678-217-5645",
"fax_number": "844-269-6494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4109 JIMMY LEE SMITH PKWY STE C",
"city": "HIRAM",
"state": "GA",
"postal_code": "301412643",
"telephone_number": "678-217-5645",
"fax_number": "844-269-6494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMAREYO",
"first_name": "BENJAMIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-06",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH025763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hiram, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.