Healthcare Provider Details

I. General information

NPI: 1316308141
Provider Name (Legal Business Name): TYLER KAST PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4387 HARRISON BLVD STE D7
OGDEN UT
84403-3267
US

IV. Provider business mailing address

4387 HARRISON BLVD STE D7
OGDEN UT
84403-3267
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-0331
  • Fax: 855-273-1877
Mailing address:
  • Phone: 801-479-0331
  • Fax: 855-273-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7967182-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: