Provider Demographics
NPI:1609988518
Name:ALDRIDGE'S FAMILY PHARMACY
Entity type:Organization
Organization Name:ALDRIDGE'S FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-929-7084
Mailing Address - Street 1:1408 BONNIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4507
Mailing Address - Country:US
Mailing Address - Phone:214-943-2322
Mailing Address - Fax:214-942-6027
Practice Address - Street 1:1408 BONNIE VIEW RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-4507
Practice Address - Country:US
Practice Address - Phone:214-943-2322
Practice Address - Fax:214-942-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336C0003X
TX58063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102493OtherPK
TX35087OtherTEXAS STATE BOARD OF PHARMACY
TX142037Medicaid