Provider Demographics
NPI:1992774616
Name:SOUTHALL, JR, FRANCIS W (RPH)
Entity type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:W
Last Name:SOUTHALL, JR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:325 W WALNUT ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1377
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:SUITE 500
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1377
Practice Address - Country:US
Practice Address - Phone:270-692-3111
Practice Address - Fax:270-692-4211
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY9019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist