Individual provider Active NPI

Robert Ashu Tambetakaw, RPH

  • Pharmacist
  • Latham, NY
National Provider Identifier
1831476662
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
056374 Issued in NY
Practice address
579 Troy Schenectady Rd
236
Latham, NY 12110-2806
Phone
(518) 783-2007
Fax
(518) 783-2229
NPI assigned
Nov 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 056374 NY Primary

Addresses

Primary practice location

579 Troy Schenectady Rd
236
Latham, NY 12110-2806

Mailing address

579 Troy Schenectady Rd
236
Latham, NY 12110-2806
Phone (518) 783-2007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
056374NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1831476662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "579 TROY SCHENECTADY RD",
            "address_2": "236",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102806",
            "telephone_number": "518-783-2007",
            "fax_number": "518-783-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "579 TROY SCHENECTADY RD",
            "address_2": "236",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102806",
            "telephone_number": "518-783-2007",
            "fax_number": "518-783-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMBETAKAW",
        "first_name": "ROBERT",
        "middle_name": "ASHU",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-08",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "056374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.