NPIMap

Organization Active NPI

Southall Pharmacy PLLC

Doing business as Extencare

  • Long Term Care Pharmacy
  • Lebanon, KY
National Provider Identifier
1417119157
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
P07263 Issued in KY
Legal business name
SOUTHALL PHARMACY PLLC
Doing business as
Extencare
Practice address
110 E Main St
Lebanon, KY 40033-1235
Phone
(270) 699-9251
NPI assigned
Jun 25, 2008
Last updated
Jun 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Francis W Southall Jr., RPH
Title
Owner
Phone
(270) 692-3111

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X P07263 KY
Nursing Facility Supplies (DME) 332BN1400X P07263 KY
Long Term Care Pharmacy 3336L0003X P07263 KY Primary

Addresses

Primary practice location

110 E Main St
Lebanon, KY 40033-1235

Mailing address

110 E Main St
Lebanon, KY 40033-1235
Phone (270) 699-9251

Other names 1

  • Extencare Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southall Pharmacy PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

110 E Main St
Lebanon, KY 40033
Phone (270) 699-9251

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1417119157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E MAIN ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331235",
            "telephone_number": "270-699-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E MAIN ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331235",
            "telephone_number": "270-699-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHALL PHARMACY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "SOUTHALL",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-692-3111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "P07263",
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "KY",
            "license": "P07263",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "KY",
            "license": "P07263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Extencare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.