Organization
ROSE DRUG OF RUSSELLVILLE INC
Active
Other names
ROSE DRUG OF RUSSELLVILLE INC
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY ISSA KASSISSIEH PHARMD (OWNER)
(501) 945-3264
Entity
Organization
Contact information
Practice address
3103 W MAIN PL, RUSSELLVILLE, AR 72801-3360
(479) 968-1323
(479) 968-1557
Mailing address
3103 W MAIN PL, RUSSELLVILLE, AR 72801-3360
(479) 968-1323
(479) 968-4988
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR13916
AR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110271407
—
AR
01
—
1994537
PK
—
Enumeration date
07/30/2006
Last updated
05/09/2024
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