Active NPI
Michael Southall
- Pharmacist
- Lebanon, KY
National Provider Identifier
1609465152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 019560
- Practice address
- 325 W Walnut St Ste 500
Lebanon, KY 40033-1379 - Phone
- (270) 692-3111
- NPI assigned
- Jan 11, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 019560 | KY | Primary |
Addresses
Primary practice location
325 W Walnut St Ste 500
Lebanon, KY 40033-1379
Mailing address
325 W Walnut St Ste 500
Lebanon, KY 40033-1379
Phone (270) 692-3111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019560 | KY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610323200000",
"number": "1609465152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 W WALNUT ST STE 500",
"city": "LEBANON",
"state": "KY",
"postal_code": "400331379",
"telephone_number": "270-692-3111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 W WALNUT ST STE 500",
"city": "LEBANON",
"state": "KY",
"postal_code": "400331379",
"telephone_number": "270-692-3111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHALL",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-11",
"last_updated": "2021-01-11",
"certification_date": "2021-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "019560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.