Healthcare Provider Details

I. General information

NPI: 1902619869
Provider Name (Legal Business Name): SAMANTHA SELENA ROFAEEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 JAMACHA RD
EL CAJON CA
92019-3201
US

IV. Provider business mailing address

1802 MCDOUGAL WAY
EL CAJON CA
92021-3685
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-9439
  • Fax:
Mailing address:
  • Phone: 619-277-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: