Provider Demographics
NPI:1962019174
Name:NUGEN, BLAKE TRAN (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:TRAN
Last Name:NUGEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 WALL ST
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2422
Mailing Address - Country:US
Mailing Address - Phone:973-362-8280
Mailing Address - Fax:
Practice Address - Street 1:611 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1612
Practice Address - Country:US
Practice Address - Phone:908-756-0008
Practice Address - Fax:908-668-8630
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04105200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist