Petra Pharmacy Services, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1000000001 Issued in CO

Legal business name

PETRA PHARMACY SERVICES, INC.

Practice address

426 Pagosa Street
Pob 120
Pagosa Springs, CO 81147

Phone

(970) 264-4166

Fax

(970) 264-3289

NPI assigned

Aug 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John D. Kutzko, PHARM D.

Title

President

Phone

(941) 321-8067

Specialties & licenses 3

Addresses

Other names 1

• Pagosa Specialty Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408060800000",
    "number": "1396144200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 PAGOSA STREET",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "81147",
            "telephone_number": "970-264-4166",
            "fax_number": "970-264-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 PAGOSA STREET",
            "address_2": "POB 120",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "81147",
            "telephone_number": "970-264-4166",
            "fax_number": "970-264-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRA PHARMACY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-15",
        "last_updated": "2014-08-15",
        "status": "A",
        "authorized_official_last_name": "KUTZKO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-321-8067",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "1000000001",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CO",
            "license": "1000000001",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "CO",
            "license": "1000000001",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pagosa Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pagosa Womens Health and Wellness Inc.
• Deborah Parker, PH.D.
• Judith Lee Patton, OTR/L
• Peak Physical Therapy Inc
• Sara Perkins, NP
• Stephanie Lynn Pham, MS CCC-SLP
• Jeanette Louise Wolfe Pike, OTR
• Pine Ridge Extend Care Center, LLC
• Pine Ridge Extended Care Center
• Pine Ridge Extended Care Center, LLC

• Community/Retail Pharmacy in Pagosa Springs, CO
• Providers in Pagosa Springs, CO by specialty
• Community/Retail Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.