Four States Apothecary LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FOUR STATES APOTHECARY LLC

Doing business as

CJ Pharmacy

Practice address

102 S Main St
Carl Junction, MO 64834-1000

Phone

(417) 649-7021

Fax

(417) 649-6269

NPI assigned

Oct 5, 2018

Last updated

Oct 5, 2018By 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

Dr. Mark Steven Mayberry Jr., PHARMDNPI 1972289528

Title

Pharmacy Ownder

Phone

(417) 529-1815

Specialties & licenses 1

Addresses

Other names 1

• CJ Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

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.

• Mark Steven Mayberry Jr., PHARMD

  • Pharmacist
  • Galena, KS
  • NPI 1972289528
  NPD Authorized official
• Brian Douglas Caswell, R.PH.

  • Community/Retail Pharmacy
  • Baxter Springs, KS
  • NPI 1689288391
  NPD
• Jerry E Botts, PHARM D

  • Pharmacist
  • Carl Junction, MO
  • NPI 1023065521
  NPD (past)
• Amelia Jolynn Hartmann, PHARMD

  • Pharmacist
  • Oswego, KS
  • NPI 1861882136
  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": "1538697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1952876948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 COMMERCIAL ST",
            "city": "OSWEGO",
            "state": "KS",
            "postal_code": "673562017",
            "telephone_number": "620-795-2233",
            "fax_number": "620-795-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S MAIN ST",
            "city": "CARL JUNCTION",
            "state": "MO",
            "postal_code": "648341000",
            "telephone_number": "417-649-7021",
            "fax_number": "417-649-6269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR STATES APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "MAYBERRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PHARMACY OWNDER",
        "authorized_official_telephone_number": "417-529-1815",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CJ Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Community Residence, Inc. (Carl Junction Rehabilitation)
• Ashley Odecia Courtney
• Family Pharmacy Inc. (Family Pharmacy #24)
• Sydney Rae Fields
• Stephanie Lynn Forth
• Katlyn Frazier, DMD
• Cean Gardner
• Stephen W Helman, DDS
• Ginny Henegar
• Tiffany Ann Huffman, FNP-C

• Community/Retail Pharmacy in Carl Junction, MO
• Providers in Carl Junction, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.