Provider Demographics
NPI:1598108201
Name:VOGT, DYLAN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:MICHAEL
Last Name:VOGT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 OBSERVATORY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3971
Mailing Address - Country:US
Mailing Address - Phone:857-221-2634
Mailing Address - Fax:
Practice Address - Street 1:7390 RANGEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7701
Practice Address - Country:US
Practice Address - Phone:719-219-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19390183500000X
MAPH233794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist