Provider Demographics
NPI:1881162857
Name:SONSHINE PHARMACY, LLC
Entity type:Organization
Organization Name:SONSHINE PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:662-840-5601
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:MOOREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38857-0668
Mailing Address - Country:US
Mailing Address - Phone:662-840-5601
Mailing Address - Fax:662-840-5604
Practice Address - Street 1:712 HIGHWAY 371
Practice Address - Street 2:
Practice Address - City:MOOREVILLE
Practice Address - State:MS
Practice Address - Zip Code:38857-7356
Practice Address - Country:US
Practice Address - Phone:662-840-5601
Practice Address - Fax:662-840-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009351594Medicaid