Provider Demographics
NPI:1669124475
Name:ASH, TESSA (RPH)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:ASH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 JAMERLEA LN
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-9636
Mailing Address - Country:US
Mailing Address - Phone:517-861-6835
Mailing Address - Fax:
Practice Address - Street 1:18005 SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3421
Practice Address - Country:US
Practice Address - Phone:810-750-1572
Practice Address - Fax:810-629-9732
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020299971835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care