Provider Demographics
NPI:1831476662
Name:TAMBETAKAW, ROBERT ASHU (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ASHU
Last Name:TAMBETAKAW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:579 TROY SCHENECTADY RD
Mailing Address - Street 2:236
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2806
Mailing Address - Country:US
Mailing Address - Phone:518-783-2007
Mailing Address - Fax:518-783-2229
Practice Address - Street 1:579 TROY SCHENECTADY RD
Practice Address - Street 2:236
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2806
Practice Address - Country:US
Practice Address - Phone:518-783-2007
Practice Address - Fax:518-783-2229
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist