Three Amigos Apothecary LLC
Organization Active NPI Community/Retail Pharmacy · Cherryvale, KS
NPI 1720154826 · NPPES record last updated Aug 6, 2020
Key facts
- NPI
- 1720154826
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2-10407 (KS)
- Legal business name
- THREE AMIGOS APOTHECARY LLC
- Practice address
- 116 N Maple St Ste B
Cherryvale, KS 67335-1729 - Phone
- (620) 336-2144
- Fax
- (620) 336-3285
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Brian Caswell
- Title
- President Pharmacist in Charge
- Phone
- (620) 674-2018
Other NPIs with the same Medicare PAC ID 1
Practitioners 3
-
Lindsay Renee Jakovljevic, PHARMD
-
Megan Kathleen Sherrell, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211025000121 | KS | Part B Supplier - Pharmacy | 9638592264 | Practice locations: Cherryvale, KS |
National Provider Directory
Locations
116 N Maple St
Ste B
Cherryvale, KS 67335
Phone (620) 336-2144
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2-10407 | KS | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
116 N Maple St Ste B
Cherryvale, KS 67335-1729
Mailing address
116 N Maple St Ste B
Cherryvale, KS 67335-1729
Phone (620) 336-2144
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2140553 | Other | PK | |
| 200867870B | Medicaid | KS |
Other names
- Cherryvale Pharmacy
Other providers in Cherryvale, KS
- Promotion Physical Therapy
- Molly Elizabeth Reynolds
- Hali Schultheiss
- Misty J Stone
- Three Amigos Apothecary LLC
- Jessica Tryon-Koehler
- Usd 447 Cherryvale
- Wilson County Hospital
- Julie A Wittum
All providers in Cherryvale, KS · Community/Retail Pharmacy in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.