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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