Provider Demographics
NPI:1861675969
Name:TAMBURO, ILENE NICOLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:NICOLE
Last Name:TAMBURO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ILENE
Other - Middle Name:NICOLE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1913 KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4511
Mailing Address - Country:US
Mailing Address - Phone:718-252-6075
Mailing Address - Fax:
Practice Address - Street 1:465 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9106
Practice Address - Country:US
Practice Address - Phone:917-326-9030
Practice Address - Fax:917-326-9035
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist