Healthcare Provider Details

I. General information

NPI: 1952210668
Provider Name (Legal Business Name): TESSA MAE BALLARD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DIPLOMACY DR
ANCHORAGE AK
99508-5926
US

IV. Provider business mailing address

2002 W CASHATT AVE
WASILLA AK
99654-8814
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-2662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number240633
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: