Provider Demographics
NPI:1942560966
Name:TAMBELLINI, BETTE SUSAN
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:SUSAN
Last Name:TAMBELLINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1029
Mailing Address - Country:US
Mailing Address - Phone:503-721-4133
Mailing Address - Fax:
Practice Address - Street 1:100 NW 20TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1029
Practice Address - Country:US
Practice Address - Phone:503-721-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6882183500000X, 1835P0018X
ORRPH-00068821835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist