Organization
SOUTHALL PHARMACY PLLC
Active
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
325 W WALNUT ST, SUITE 500, LEBANON, KY 40033-1377
(270) 692-3111
(270) 692-4211
Mailing address
325 W WALNUT ST, SUITE 500, LEBANON, KY 40033-1377
(270) 692-3111
(270) 692-4211
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
P02451
KY
332BD1200X
Dialysis Equipment & Supplies (DME)
P02451
KY
332BN1400X
Nursing Facility Supplies (DME)
P02451
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
P02451
KY
332BX2000X
Oxygen Equipment & Supplies (DME)
P02451
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90040783
—
KY
Enumeration date
03/21/2007
Last updated
03/02/2009
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