Provider Demographics
NPI:1598885410
Name:SONSALLA, ERIC S (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:S
Last Name:SONSALLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 172ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:MARMARTH
Mailing Address - State:ND
Mailing Address - Zip Code:58643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313
Practice Address - Country:US
Practice Address - Phone:406-778-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist