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NPI Code Detail

MEDICARE: DR. RANDY ISSA KASSISSIEH PHARMD

MEDICARE: DR. RANDY ISSA KASSISSIEH PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPD11644AR

General Provider Information

NPI Number : 1588950752
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDY ISSA KASSISSIEH PHARMD
Provider Business Mailing Address
First Line : 105 MIRAMAR BLVD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72223-3242
Country : US
Telephone Number : 501-772-1123
Fax Number :
Provider Business Practice Location Address
First Line : 4307 E BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-4124
Country : US
Telephone Number : 501-945-3264
Fax Number : 501-945-6976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2011
Last Update Date : 12/10/2020

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