Healthcare Provider Details

I. General information

NPI: 1043151319
Provider Name (Legal Business Name): DYLAN KRUPP PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-4636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14197613-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: