Provider Demographics
NPI:1982648770
Name:STACK, ROBERT H (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:STACK
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:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-0237
Mailing Address - Country:US
Mailing Address - Phone:860-371-4502
Mailing Address - Fax:860-927-0015
Practice Address - Street 1:3 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1711
Practice Address - Country:US
Practice Address - Phone:860-371-4502
Practice Address - Fax:860-927-0015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy