Mantachie Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

17079/1.1 Issued in MS

Legal business name

MANTACHIE PHARMACY LLC

Practice address

3309 Highway 371 N
Mantachie, MS 38855-7267

Phone

(662) 282-7000

Fax

(662) 282-7007

NPI assigned

Apr 19, 2018

Organization subpart

No

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

Authorized official

Name

Katlyn SpradlingNPI 1306330253

Title

Pharmacist

Phone

(662) 282-7000

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Mantachie Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Tax ID family

Mantachie Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mantachie Pharmacy LLC

  • Long Term Care Pharmacy
  • Mantachie, MS
  • NPI 1902474190
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katlyn Spradling

  • Pharmacist
  • Mantachie, MS
  • NPI 1306330253
  NPD Authorized official

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1992292536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388550096",
            "telephone_number": "662-282-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3309 HIGHWAY 371 N",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388557267",
            "telephone_number": "662-282-7000",
            "fax_number": "662-282-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTACHIE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-19",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "SPRADLING",
        "authorized_official_first_name": "KATLYN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "662-282-7000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "17079/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177084",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mantachie Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mantachie Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bonnie Renee' Jones, MSN, APRN, FNP-C
• Katherine E Jones, FNP-BC
• Ginger Little
• James Brandon Loden
• Mantachie Pharmacy LLC
• Mantachie Rural Health Care, Inc
• Mantachie Rural Health Care, Inc
• Mantachie Rural Health Care, Inc
• Mantachie Rural Health Care, Inc
• Mantachie Rural Health Care, Inc. Dental

• All providers in Mantachie, MS
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.