Provider Demographics
NPI:1821048935
Name:FARMER'S PRESCRIPTION SHOP
Entity Type:Organization
Organization Name:FARMER'S PRESCRIPTION SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CDM
Authorized Official - Phone:770-867-9072
Mailing Address - Street 1:232 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2277
Mailing Address - Country:US
Mailing Address - Phone:770-867-9072
Mailing Address - Fax:770-867-8229
Practice Address - Street 1:232 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2277
Practice Address - Country:US
Practice Address - Phone:770-867-9072
Practice Address - Fax:770-867-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00027805BMedicaid
GA00027805AMedicaid
GA0493880001Medicare NSC