Healthcare Provider Details

I. General information

NPI: 1356665970
Provider Name (Legal Business Name): FARMERS MEDSHOPPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 HIGHWAY 587
FOXWORTH MS
39483-5026
US

IV. Provider business mailing address

PO BOX 669
FOXWORTH MS
39483-0669
US

V. Phone/Fax

Practice location:
  • Phone: 601-424-3530
  • Fax: 601-424-3533
Mailing address:
  • Phone: 601-424-3530
  • Fax: 601-424-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON FARMER
Title or Position: OWNER, PIC
Credential: RPH
Phone: 601-424-3530