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General NPI Number Information
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NPI Number | 1497871859
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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 | 03/21/2007
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 325 W WALNUT ST SUITE 500
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City | LEBANON
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State | KY
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Zip | 40033-1377
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Country | US
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Telephone | 270-692-3111
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Fax | 270-692-4211
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Provider Business Mailing Address
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Address Line | 325 W WALNUT ST SUITE 500
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City | LEBANON
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State | KY
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Zip | 40033-1377
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Country | US
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Telephone | 270-692-3111
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Fax | 270-692-4211
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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 | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number | P02451
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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 | P02451
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | P02451
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | P02451
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | P02451
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License Number State | KY
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