Provider Demographics
NPI:1356665970
Name:FARMERS MEDSHOPPE LLC
Entity type:Organization
Organization Name:FARMERS MEDSHOPPE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-424-3530
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:FOXWORTH
Mailing Address - State:MS
Mailing Address - Zip Code:39483-0669
Mailing Address - Country:US
Mailing Address - Phone:601-424-3530
Mailing Address - Fax:601-424-3533
Practice Address - Street 1:62 HIGHWAY 587
Practice Address - Street 2:
Practice Address - City:FOXWORTH
Practice Address - State:MS
Practice Address - Zip Code:39483-5026
Practice Address - Country:US
Practice Address - Phone:601-424-3530
Practice Address - Fax:601-424-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MS084123336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124509OtherPK
MS8950519Medicaid