Provider Demographics
NPI:1932377421
Name:STACKPOLE, ROBERT HENRY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HENRY
Last Name:STACKPOLE
Suffix:JR
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 1:17 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4420
Mailing Address - Country:US
Mailing Address - Phone:973-875-1945
Mailing Address - Fax:973-875-1945
Practice Address - Street 1:530 ROUTE 515
Practice Address - Street 2:UNIT 1
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3215
Practice Address - Country:US
Practice Address - Phone:973-764-5380
Practice Address - Fax:973-764-5996
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01772600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01772600OtherRPH STATE LICENSE NUMBER