Organization
MANTACHIE PHARMACY LLC
Active
Other names
Mantachie Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KATLYN SPRADLING (PHARMACIST)
(662) 282-7000
Entity
Organization
Contact information
Practice address
3309 HIGHWAY 371 N, MANTACHIE, MS 38855-7267
(662) 282-7000
(662) 282-7007
Mailing address
PO BOX 96, MANTACHIE, MS 38855-0096
(662) 282-7000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
17079/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177084
PK
—
Enumeration date
04/19/2018
Last updated
09/18/2025
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