Provider Demographics
NPI:1609909316
Name:STACKPOLE, ROBIN L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:L
Last Name:STACKPOLE
Suffix:
Gender:F
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:RR 1 BOX 188
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26347-9724
Mailing Address - Country:US
Mailing Address - Phone:304-842-0829
Mailing Address - Fax:
Practice Address - Street 1:627 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-5103
Practice Address - Country:US
Practice Address - Phone:304-366-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist