Provider Demographics
NPI:1376718262
Name:BLEZNICK, ALAN E (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:BLEZNICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2544
Mailing Address - Country:US
Mailing Address - Phone:303-548-2633
Mailing Address - Fax:
Practice Address - Street 1:3502 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3345
Practice Address - Country:US
Practice Address - Phone:866-355-7797
Practice Address - Fax:888-551-6289
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01759600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist