Provider Demographics
NPI:1861085813
Name:FARMER, STACY ELIZABETH (PHARMACIST RPH)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ELIZABETH
Last Name:FARMER
Suffix:
Gender:F
Credentials:PHARMACIST RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3396
Mailing Address - Country:US
Mailing Address - Phone:318-336-5112
Mailing Address - Fax:318-336-9745
Practice Address - Street 1:307 CARTER ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3396
Practice Address - Country:US
Practice Address - Phone:318-336-5112
Practice Address - Fax:318-336-9745
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist