Healthcare Provider Details

I. General information

NPI: 1841113784
Provider Name (Legal Business Name): SOUTHALL FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W. WALNUT ST. SUITE 500
LEBANON KY
40033
US

IV. Provider business mailing address

325 W. WALNUT ST. SUITE 500
LEBANON KY
40033
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SOUTHALL
Title or Position: PHARMACY/FUTURE OWNER
Credential:
Phone: 859-619-1466