Provider Demographics
NPI:1669813713
Name:RASSAM, DAWOOD (RPH)
Entity Type:Individual
Prefix:
First Name:DAWOOD
Middle Name:
Last Name:RASSAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242438
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0025
Mailing Address - Country:US
Mailing Address - Phone:619-569-0120
Mailing Address - Fax:
Practice Address - Street 1:1521 MERRILL DR STE D220
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1654
Practice Address - Country:US
Practice Address - Phone:501-660-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68434183500000X
ARC14966183500000X
TX63428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist