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General NPI Number Information
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NPI Number | 1184923377
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Entity Type | Individual
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Provider Name | BRUCE ALAN FELTS RPH
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Gender | Male
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 501 E EMMITT AVE
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City | WAVERLY
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State | OH
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Zip | 45690-1206
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Country | US
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Telephone | 740-941-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 683 CONLEY RD
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City | BEAVER
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State | OH
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Zip | 45613-9636
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Country | US
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Telephone | 740-988-0016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03110056
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License Number State | OH
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