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General NPI Number Information
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NPI Number | 1558078634
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Entity Type | Organization
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Legal Business Name | ROOTS PHARMACY
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 13001 EASTLAKE BLVD STE 107
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City | EL PASO
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State | TX
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Zip | 79928-6312
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Country | US
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Telephone | 915-200-3762
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Fax |
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Provider Business Mailing Address
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Address Line | 3416 BLAZON GOLD WAY
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City | EL PASO
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State | TX
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Zip | 79936-0674
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SAMUEL O MELFAH
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Credential | PHARMD
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Telephone | 915-200-3762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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