MEDICARE: FRANCIS W SOUTHALL JR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	P02451	KY
2	3336C0003X	Community/Retail Pharmacy	P02451	KY
3	333600000X	Pharmacy	P02451	KY
4	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891798336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANCIS W SOUTHALL JR

Provider Business Mailing Address
First Line	:	325 W WALNUT ST STE 500
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1379
Country	:	US
Telephone Number	:	270-692-3111
Fax Number	:	270-692-4211

Provider Business Practice Location Address
First Line	:	325 W WALNUT ST STE 500
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1379
Country	:	US
Telephone Number	:	270-692-3111
Fax Number	:	270-692-4211

Authorized Official
Title or Position	:	OWNER
Name	:	FRANCIS W SOUTHALL, JR
Credential	:
Telephone Number	:	270-692-3111

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	12/31/2025

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Directions to “FRANCIS W SOUTHALL JR ” Practice Location

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