NPIMap

Organization Active NPI

D.L. Baker Drug Co., Inc.

Doing business as Cornerstone Pharmacy Rose City

  • Community/Retail Pharmacy
  • North Little Rock, AR
National Provider Identifier
1699789545
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
D.L. BAKER DRUG CO., INC.
Doing business as
Cornerstone Pharmacy Rose City
Practice address
4307 E Broadway St
North Little Rock, AR 72117-4124
Phone
(501) 945-3264
Fax
(501) 945-6976
NPI assigned
Jul 28, 2006
Last updated
Jun 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Authorized official

Name
Mr. Randy Issa Kassissieh, PHARMDNPI 1588950752
Title
Pharmacist/Owner
Phone
(501) 945-3264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PD06101 AR
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

4307 E Broadway St
North Little Rock, AR 72117-4124

Mailing address

4307 E Broadway St
North Little Rock, AR 72117-4124
Phone (501) 945-3264

Other identifiers 1

IdentifierTypeStateIssuer
100180407MedicaidAR

Other names 1

  • Cornerstone Pharmacy Rose City Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051103001003 AR Part B Supplier - Mass Immunization (Roster Biller Only) 8224056619 Practice locations: North Little Rock, AR
O20220309000358 AR DME Supplier - Pharmacy 8224056619 Practice locations: North Little Rock, AR

National Provider Directory

National Provider Directory
Tax ID family
Cornerstone Pharmacy Rose City2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4133 E Broadway St
North Little Rock, AR 72117
Phone (501) 945-3264

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1699789545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": [],
    "basic": {
        "organization_name": "D.L. BAKER DRUG CO., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "KASSISSIEH",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "ISSA",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "501-945-3264",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD06101",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100180407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Pharmacy Rose City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 23, 2022; 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.