Three Amigos Apothecary LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-13070 Issued in KS

Legal business name

THREE AMIGOS APOTHECARY LLC

Doing business as

Four States Pharmacy

Practice address

1605 K66
Galena, KS 66739-4306

Phone

(620) 783-4441

Fax

(620) 783-1690

NPI assigned

Feb 18, 2012

Last updated

Oct 16, 2025By 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

Owner

Phone

(620) 674-2018

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• FOUR STATES 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 Cherryvale Pharmacy

  • Community/Retail Pharmacy
  • Cherryvale, KS
  • NPI 1720154826

  9638592264

  Same PAC ID

Locations

Practitioners 4

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.

• Lindsay Renee Jakovljevic, PHARMD

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

  • Pharmacist
  • Galena, KS
  • NPI 1669149472
  NPD
• McKayla Edwards

  • Pharmacist
  • Pittsburg, KS
  • NPI 1679195291
  NPD (past)
• Mark Steven Mayberry Jr., PHARMD

  • Pharmacist
  • Galena, KS
  • NPI 1972289528
  NPD (past)

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

{
    "created_epoch": "1329523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1992078117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 K66 STE B",
            "city": "GALENA",
            "state": "KS",
            "postal_code": "667394306",
            "telephone_number": "620-783-1636",
            "fax_number": "620-783-1690"
        },
        {
            "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": "620-783-4441",
            "fax_number": "620-783-1690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE AMIGOS APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-18",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "CASWELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "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": "2-13070",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200450780A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133997",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200867870A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOUR STATES PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FOUR STATES PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Bryan Sperry, CRNA
• Stateline Surgery Center, LLC
• Mariah Dawn Stone, PTA
• Kurt M Stork, PT
• Rhonda Stork, PT
• Paul W Toma, DO
• Shannon Marie Vogt, MPT, CHT
• Terry L Vogt, PA
• Linda L Vonwedell, FNP
• Keanon Walker, CRNA

• Community/Retail Pharmacy in Galena, KS
• Providers in Galena, 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 Oct 16, 2025; 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.