Organization
SOUTHALL PHARMACY PLLC
Active
Other names
Extencare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANCIS W SOUTHALL JR. RPH (OWNER)
(270) 692-3111
Entity
Organization
Contact information
Practice address
110 E MAIN ST, LEBANON, KY 40033-1235
(270) 699-9251
Mailing address
110 E MAIN ST, LEBANON, KY 40033-1235
(270) 699-9251
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P07263
KY
332BN1400X
Nursing Facility Supplies (DME)
P07263
KY
3336L0003X
Long Term Care Pharmacy
Primary
P07263
KY
Other
Enumeration date
06/25/2008
Last updated
06/25/2008
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