Organization
PETRA PHARMACY SERVICES, INC.
Active
Organization
PETRA PHARMACY SERVICES, INC.
Active
Other names
Pagosa Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN D. KUTZKO PHARM D. (PRESIDENT)
(941) 321-8067
Entity
Organization
Contact information
Practice address
426 PAGOSA STREET, POB 120, PAGOSA SPRINGS, CO 81147
(970) 264-4166
(970) 264-3289
Mailing address
426 PAGOSA STREET, PAGOSA SPRINGS, CO 81147
(970) 264-4166
(970) 264-3289
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1000000001
CO
3336C0004X
Compounding Pharmacy
1000000001
CO
3336S0011X
Specialty Pharmacy
1000000001
CO
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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