Active NPI
Randy Issa Kassissieh, PHARMD
- Pharmacist
- North Little Rock, AR
National Provider Identifier
1588950752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD11644
- Practice address
- 4307 E Broadway St
North Little Rock, AR 72117-4124 - Phone
- (501) 945-3264
- Fax
- (501) 945-6976
- NPI assigned
- Jun 24, 2011
- 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 | PD11644 | AR | Primary |
Addresses
Primary practice location
4307 E Broadway St
North Little Rock, AR 72117-4124
Mailing address
105 Miramar Blvd
Little Rock, AR 72223-3242
Phone (501) 772-1123
Other practice location 1
4307 E Broadway St
North Little Rock, AR 72117-4124
Phone (501) 945-3264
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD11644 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| D.L. Baker Drug Co., Inc. | Past | Accepting new patients | |
| 360 Wellness Clinic LLC | Past | Accepting new patients | |
| D.L. Baker Drug Co., Inc. | Pharmacist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Long Term Care Pharmacy
- North Little Rock, AR
- NPI 1700517307
-
- Clinic/Center
- Benton, AR
- NPI 1366048803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607558400000",
"number": "1588950752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 MIRAMAR BLVD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722233242",
"telephone_number": "501-772-1123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4307 E BROADWAY ST",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721174124",
"telephone_number": "501-945-3264",
"fax_number": "501-945-6976"
}
],
"practiceLocations": [
{
"address_1": "4307 E Broadway St",
"address_purpose": "LOCATION",
"city": "North Little Rock",
"state": "AR",
"postal_code": "721174124",
"country_code": "US",
"telephone_number": "501-945-3264",
"fax_number": "501-945-6976",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KASSISSIEH",
"first_name": "RANDY",
"middle_name": "ISSA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-24",
"last_updated": "2020-12-10",
"certification_date": "2020-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD11644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.