Provider Demographics
NPI:1063662898
Name:RAFIE, SALLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:RAFIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ASAL
Other - Middle Name:
Other - Last Name:SADATRAFIEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:200 W ARBOR DR DEPT 8765
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8765
Mailing Address - Country:US
Mailing Address - Phone:858-210-9619
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR DEPT 8765
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8765
Practice Address - Country:US
Practice Address - Phone:858-210-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61116183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy