MEDICARE: BRUCE ALAN FELTS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03110056	OH

General Provider Information

NPI Number	:	1184923377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE ALAN FELTS RPH

Provider Business Mailing Address
First Line	:	683 CONLEY RD
Second Line	:
City	:	BEAVER
State	:	OH
Zip	:	45613-9636
Country	:	US
Telephone Number	:	740-988-0016
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 E EMMITT AVE
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-1206
Country	:	US
Telephone Number	:	740-941-3017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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