Mark Steven Mayberry Jr., PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

1-15280 Issued in KS

Practice address

1605 K66
Galena, KS 66739-4306

Phone

(620) 783-1636

Fax

(620) 783-1690

NPI assigned

Jun 27, 2023

Last updated

Jun 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Four States Apothecary LLC

  dba CJ Pharmacy

  • Community/Retail Pharmacy
  • Carl Junction, MO
  • NPI 1952876948
  NPD Authorized official
• Three Amigos Apothecary LLC

  dba Four States Pharmacy

  • Community/Retail Pharmacy
  • Galena, KS
  • NPI 1992078117
  NPD (past)

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1972289528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 ARLINGTON LN",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041779",
            "telephone_number": "417-529-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 K66",
            "city": "GALENA",
            "state": "KS",
            "postal_code": "667394306",
            "telephone_number": "620-783-1636",
            "fax_number": "620-783-1690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "MARK",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS47973",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2021009164",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KS",
            "license": "1-15280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Hal Liljenquist
• John F Line, PA-C
• Sydnee Maffei, PTA
• Keith Allen Mallatt, O.D.
• Katie L Marsh, PA
• Brent Wayne McBrien, PTA
• Mark E McNemar, DO
• McPherson Medical & Diagnostic LLC (American Medical Missouri)
• Mercy Specialty Hospital Southeast Kansas
• Aarika Danielle Middleton, PA-C

• Pharmacist in Galena, KS
• Providers in Galena, KS by specialty
• Pharmacist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.