Provider Demographics
NPI:1497250732
Name:BARTH, DYLAN MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAEL
Last Name:BARTH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 1ST ST SW APT B2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-0337
Mailing Address - Country:US
Mailing Address - Phone:513-502-6379
Mailing Address - Fax:
Practice Address - Street 1:1301 1ST ST SW APT B2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-0337
Practice Address - Country:US
Practice Address - Phone:513-502-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123364183500000X
OH3236869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist