Rose Drug of Russellville Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR13916 Issued in AR

Legal business name

ROSE DRUG OF RUSSELLVILLE INC

Practice address

3103 W Main PL
Russellville, AR 72801-3360

Phone

(479) 968-1323

Fax

(479) 968-1557

NPI assigned

Jul 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randy Issa Kassissieh, PHARMD

Title

Owner

Phone

(501) 945-3264

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• ROSE DRUG OF RUSSELLVILLE INC Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1669487294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 W MAIN PL",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013360",
            "telephone_number": "479-968-1323",
            "fax_number": "479-968-4988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 W MAIN PL",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013360",
            "telephone_number": "479-968-1323",
            "fax_number": "479-968-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE DRUG OF RUSSELLVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "KASSISSIEH",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "ISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-945-3264",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR13916",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110271407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1994537",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROSE DRUG OF RUSSELLVILLE INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ROSE DRUG OF RUSSELLVILLE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Andrew Roller, PHARM.D.
• Rosemary A Rolniak, PHYSICAL THERAPIST
• Shawnelle Roman, LPN
• Ryan Matthew Rooke, COTA
• Rose & Wells, Inc.
• Rose Drug of Russellville, Inc
• Rose Drug of Russellville, Inc
• Kelsey Marissa Ross
• Stephanie A. Roth, DPM
• Mittie Rowland

• Community/Retail Pharmacy in Russellville, AR
• Providers in Russellville, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.