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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