Provider Demographics
NPI:1588950752
Name:KASSISSIEH, RANDY ISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ISSA
Last Name:KASSISSIEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MIRAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3242
Mailing Address - Country:US
Mailing Address - Phone:501-772-1123
Mailing Address - Fax:
Practice Address - Street 1:4307 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-4124
Practice Address - Country:US
Practice Address - Phone:501-945-3264
Practice Address - Fax:501-945-6976
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist