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Organization

ROSE DRUG OF RUSSELLVILLE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RANDY ISSA KASSISSIEH (OWNER)
(501) 945-3264
Entity
Organization

Contact information

Practice address
3103 W MAIN PL, RUSSELLVILLE, AR 72801-3360
(479) 968-1050
(479) 968-1557
Mailing address
3103 W MAIN PL, RUSSELLVILLE, AR 72801-3360
(479) 968-1050
(479) 968-1557

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0413916
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110621716
AR
Enumeration date
08/01/2006
Last updated
06/12/2023
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