Organization
SELAH MOUNTAIN PHARMACY LLC
Active
Organization
SELAH MOUNTAIN PHARMACY LLC
Active
Other names
Selah Mountain Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KUTZKO PHARM D (MANAGING MEMBER)
(941) 321-8067
Entity
Organization
Contact information
Practice address
426 PAGOSA STREET, PAGOSA SPRINGS, CO 81147
(970) 264-0126
(970) 507-6111
Mailing address
PO BOX 5949, PAGOSA SPRINGS, CO 81147-5949
(970) 264-0126
(970) 507-6111
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497211379
—
CO
Enumeration date
02/15/2019
Last updated
02/05/2021
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