Organization
THREE AMIGOS APOTHECARY LLC
Active
Organization
THREE AMIGOS APOTHECARY LLC
Active
Other names
FOUR STATES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN CASWELL (OWNER)
(620) 674-2018
Entity
Organization
Contact information
Practice address
1605 K66, GALENA, KS 66739-4306
(620) 783-4441
(620) 783-1690
Mailing address
1605 K66 STE B, GALENA, KS 66739-4306
(620) 783-1636
(620) 783-1690
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-13070
KS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200450780A
—
OK
05
—
200867870A
—
KS
01
—
2133997
PK
—
Enumeration date
02/18/2012
Last updated
10/16/2025
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