Provider Demographics
NPI:1255445573
Name:BLEZNICK, HOWARD L (RPH)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:L
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 1:22 ALMADERA DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2442
Mailing Address - Country:US
Mailing Address - Phone:973-904-0074
Mailing Address - Fax:
Practice Address - Street 1:595 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2113
Practice Address - Country:US
Practice Address - Phone:973-777-2428
Practice Address - Fax:973-777-8745
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01402200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist