Provider Demographics
NPI:1790886166
Name:ALDRIDGE, MICHAEL BLAKE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BLAKE
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BRANDY CREEK CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2332
Mailing Address - Country:US
Mailing Address - Phone:321-953-4792
Mailing Address - Fax:
Practice Address - Street 1:5270 BABCOCK ST NE STE 120
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-8630
Practice Address - Country:US
Practice Address - Phone:321-728-7041
Practice Address - Fax:321-728-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist