Provider Demographics
NPI:1871194068
Name:CASSAT, KENNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNA
Middle Name:
Last Name:CASSAT
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 1:7710 S SHORELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8472
Mailing Address - Country:US
Mailing Address - Phone:501-690-4704
Mailing Address - Fax:
Practice Address - Street 1:400 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3813
Practice Address - Country:US
Practice Address - Phone:501-847-4615
Practice Address - Fax:501-847-7693
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist