Provider Demographics
NPI:1891798336
Name:FRANCIS W SOUTHALL JR
Entity Type:Organization
Organization Name:FRANCIS W SOUTHALL JR
Other - Org Name:SOUTHALL PHARMACY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOUTHALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-692-3111
Mailing Address - Street 1:325 W WALNUT ST
Mailing Address - Street 2:STE 500
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1379
Mailing Address - Country:US
Mailing Address - Phone:270-692-3111
Mailing Address - Fax:270-692-4211
Practice Address - Street 1:325 W WALNUT ST
Practice Address - Street 2:STE 500
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033
Practice Address - Country:US
Practice Address - Phone:270-692-3111
Practice Address - Fax:270-692-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-28
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP02451333600000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90040783Medicaid
KY54027925Medicaid
KY90040783Medicaid