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Contact Information

PETRA PHARMACY SERVICES, INC.
426 PAGOSA STREET
POB 120
PAGOSA SPRINGS, CO81147
 Phone: 970-264-4166
 Fax: 970-264-3289
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
 

Specialty Pharmacy

3336S0011X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PETRA PHARMACY SERVICES, INC.

NPI # 1396144200
LBN Legal business name PETRA PHARMACY SERVICES, INC.
Authorized official JOHN KUTZKO - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 08/15/2014
Last updated 08/15/2014 - About 12 years ago
Identifiers
CO License # 1000000001
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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