Organization Name:  SOUTHALL PHARMACY PLLC


Practice Location:
325 W WALNUT ST SUITE 500 LEBANON, KY 40033 US
Tel: 270-692-3111  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BD1200X	Suppliers Durable Medical Equipment & Medical Supplies Dialysis Equipment & Supplies	KY	P02451
N	332BN1400X	Suppliers Durable Medical Equipment & Medical Supplies	KY	P02451
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies	KY	P02451
N	332BX2000X	Suppliers Durable Medical Equipment & Medical Supplies	KY	P02451
Y	332B00000X	Suppliers Durable Medical Equipment & Medical Supplies	KY	P02451

Other Provider Identifiers:

Issuer	Number	State	Type
	90040783	KY	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin