Provider Demographics
NPI:1598231912
Name:BALDRIDGE GROUP LLC
Entity Type:Organization
Organization Name:BALDRIDGE GROUP LLC
Other - Org Name:CLEARFORK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:BALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-903-2964
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:BROCK
Practice Address - State:TX
Practice Address - Zip Code:76066-3542
Practice Address - Country:US
Practice Address - Phone:817-609-4992
Practice Address - Fax:817-599-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32435OtherSTATE PHARMACY LICENSE
FC8157845OtherDEA LICENSE