Rose Drug of Russellville, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0413916 Issued in AR

Legal business name

ROSE DRUG OF RUSSELLVILLE, INC

Practice address

3103 W Main PL
Russellville, AR 72801-3360

Phone

(479) 968-1050

Fax

(479) 968-1557

NPI assigned

Aug 1, 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

Title

Owner

Phone

(501) 945-3264

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1952317422",
    "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": "479-968-1050",
            "fax_number": "479-968-1557"
        },
        {
            "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": "479-968-1050",
            "fax_number": "479-968-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE DRUG OF RUSSELLVILLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "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"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AR",
            "license": "0413916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110621716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rose Drug of Russellville Inc
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• Kelsey Marissa Ross
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• Rpi Rehab Operations, LLC

• Durable Medical Equipment & Medical Supplies in Russellville, AR
• Providers in Russellville, AR by specialty
• Durable Medical Equipment & Medical Supplies in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.