MEDICARE: FEI TSO 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	90829	CA

General Provider Information

NPI Number	:	1023994498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEI TSO RPH

Provider Business Mailing Address
First Line	:	325 9TH ST
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-1909
Country	:	US
Telephone Number	:	530-760-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	8925 MADISON AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4009
Country	:	US
Telephone Number	:	916-965-1541
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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