Selah Mountain Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SELAH MOUNTAIN PHARMACY LLC

Doing business as

Selah Mountain Pharmacy

Practice address

426 Pagosa Street
Pagosa Springs, CO 81147

Phone

(970) 264-0126

Fax

(970) 507-6111

NPI assigned

Feb 15, 2019

Last updated

Feb 5, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Kutzko, PHARM DNPI 1205358918

Title

Managing Member

Phone

(941) 321-8067

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Selah Mountain Pharmacy Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John D. Kutzko, PHARM D.

  • Pharmacist
  • Pagosa Springs, CO
  • NPI 1205358918
  NPD Authorized official

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

{
    "created_epoch": "1550188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1497211379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5949",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811475949",
            "telephone_number": "970-264-0126",
            "fax_number": "970-507-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 PAGOSA STREET",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "81147",
            "telephone_number": "970-264-0126",
            "fax_number": "970-507-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELAH MOUNTAIN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-15",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "KUTZKO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "941-321-8067",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497211379",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Selah Mountain Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Selah Mountain Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Feb 5, 2021; 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.