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SELAH MOUNTAIN PHARMACY LLC NPI 1497211379


NPI Information

NPI: 1497211379
Provider Name: SELAH MOUNTAIN PHARMACY LLC

Doing Business As: SELAH MOUNTAIN PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
426 PAGOSA STREET
PAGOSA SPRINGS, CO
ZIP 81147
Phone: (970) 264-0126
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SELAH MOUNTAIN PHARMACY LLC is a community/retail pharmacy pharmacy in Pagosa Springs, CO. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. SELAH MOUNTAIN PHARMACY LLC NPI is 1497211379. The provider is registered as an organization entity type.
The provider Is Doing Business As Selah Mountain Pharmacy.

The provider's business location address is:

426 PAGOSA STREET
PAGOSA SPRINGS, CO
ZIP 81147
Phone: (970) 264-0126
Fax: (970) 507-6111

The provider's authorized official is John Kutzko .
The authorized official title is Managing Member and has the following contact phone number (941) 321-8067.

The enumeration date for this NPI number is 2/15/2019 and was last updated on 2/5/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
23336C0004XPharmacyCompounding PharmacyNo
33336C0003XPharmacyCommunity/Retail PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11497211379MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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