Provider Demographics
NPI:1467159798
Name:STACKHOUSE, ROBERT S (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:STACKHOUSE
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 1:8465 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:ALLENSPARK
Mailing Address - State:CO
Mailing Address - Zip Code:80510-9504
Mailing Address - Country:US
Mailing Address - Phone:928-230-5216
Mailing Address - Fax:
Practice Address - Street 1:451 E WONDERVIEW AVE
Practice Address - Street 2:ATTN: PHARMACY DEPARTMENT
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:970-586-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0014680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist