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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