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General NPI Number Information
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NPI Number | 1417119157
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Entity Type | Organization
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Legal Business Name | SOUTHALL PHARMACY PLLC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 110 E MAIN ST
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City | LEBANON
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State | KY
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Zip | 40033-1235
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Country | US
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Telephone | 270-699-9251
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E MAIN ST
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City | LEBANON
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State | KY
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Zip | 40033-1235
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Country | US
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Telephone | 270-699-9251
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANCIS W SOUTHALL JR.
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Credential | RPH
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Telephone | 270-692-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | P07263
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | P07263
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | P07263
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License Number State | KY
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