Provider Demographics
NPI:1992284939
Name:RISSINGER, CASEY (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:RISSINGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 N CENTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-9449
Mailing Address - Country:US
Mailing Address - Phone:479-296-6041
Mailing Address - Fax:
Practice Address - Street 1:2127 N CENTER ST STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-9449
Practice Address - Country:US
Practice Address - Phone:479-296-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist