Healthcare Provider Details

I. General information

NPI: 1669124475
Provider Name (Legal Business Name): TESSA ASH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18005 SILVER PKWY
FENTON MI
48430-3421
US

IV. Provider business mailing address

5470 JAMERLEA LN
FOWLERVILLE MI
48836-9636
US

V. Phone/Fax

Practice location:
  • Phone: 810-750-1572
  • Fax: 810-629-9732
Mailing address:
  • Phone: 517-861-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302029997
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: