Provider Demographics
NPI:1699241018
Name:BALDRIDGE, STEVE ROGERS (RPH)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:ROGERS
Last Name:BALDRIDGE
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 1:151 ROCKHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-6010
Mailing Address - Country:US
Mailing Address - Phone:817-903-2964
Mailing Address - Fax:
Practice Address - Street 1:1130 FM 1189 STE 109
Practice Address - Street 2:
Practice Address - City:MILLSAP
Practice Address - State:TX
Practice Address - Zip Code:76066-3542
Practice Address - Country:US
Practice Address - Phone:817-903-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37252OtherPHARMACIST STATE LICENSE