Three Amigos Apothecary LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-10407 Issued in KS

Legal business name

THREE AMIGOS APOTHECARY LLC

Doing business as

Cherryvale Pharmacy

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

Last updated

Aug 6, 2020By 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

Brian Caswell

Title

President Pharmacist in Charge

Phone

(620) 674-2018

Specialties & licenses 3

Addresses

Other names 1

• Cherryvale Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Three Amigos Apothecary LLC

  dba Four States Pharmacy

  • Community/Retail Pharmacy
  • Galena, KS
  • NPI 1992078117

  9638592264

  Same PAC ID

Locations

Practitioners 3

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.

• McKayla Edwards

  • Pharmacist
  • Pittsburg, KS
  • NPI 1679195291
  NPD (past)
• Lindsay Renee Jakovljevic, PHARMD

  • Pharmacist
  • Galena, KS
  • NPI 1043944978
  NPD (past)
• Megan Kathleen Sherrell, PHARMD

  • Pharmacist
  • Galena, KS
  • NPI 1669149472
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1720154826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 N MAPLE ST STE B",
            "city": "CHERRYVALE",
            "state": "KS",
            "postal_code": "673351729",
            "telephone_number": "620-336-2144",
            "fax_number": "620-336-3285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 N MAPLE ST STE B",
            "city": "CHERRYVALE",
            "state": "KS",
            "postal_code": "673351729",
            "telephone_number": "620-336-2144",
            "fax_number": "620-336-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE AMIGOS APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "CASWELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "620-674-2018"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "2-10407",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherryvale Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cherryvale Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Promotion Physical Therapy
• Molly Elizabeth Reynolds, D.D.S.
• Hali Schultheiss, APRN
• Misty J Stone, PTA
• Three Amigos Apothecary LLC (Cherryvale Pharmacy)
• Jessica Tryon-Koehler
• Usd 447 Cherryvale
• Wilson County Hospital (Cherryvale Family Medicine)
• Julie A Wittum, P.T.

• Community/Retail Pharmacy in Cherryvale, KS
• Providers in Cherryvale, KS by specialty
• Community/Retail Pharmacy in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.