| Organization Name: | PETRA PHARMACY SERVICES, INC. |
| NPI Number: | 1396144200 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN D. KUTZKO (PRESIDENT) |
| Mailing Address: | 426 Pagosa Street Pob 120 Pagosa Springs |
| State: | CO US |
| Postal Code: | 81147 |
| Phone Number: | 9702644166 |
| Fax Number: | 9702643289 |
| NPI Enumeration Date: | 08/15/2014 |
| NPI Last Update Date: | 08/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336S0011X |
| License Number: | 1000000001 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Specialty Pharmacy |
| Taxonomy Definition: | A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration. |