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General NPI Number Information
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NPI Number | 1467159798
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Entity Type | Individual
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Provider Name | ROBERT S STACKHOUSE RPH
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Gender | Male
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 451 E WONDERVIEW AVE ATTN: PHARMACY DEPARTMENT
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City | ESTES PARK
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State | CO
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Zip | 80517
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Country | US
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Telephone | 970-586-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 8465 HIGHWAY 7
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City | ALLENSPARK
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State | CO
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Zip | 80510-9504
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Country | US
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Telephone | 928-230-5216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA.0014680
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License Number State | CO
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