Provider Demographics
NPI:1861034738
Name:RAFFERTY, SAMANTHA E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:E
Last Name:RAFFERTY
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 1:11201 W 107TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3534
Mailing Address - Country:US
Mailing Address - Phone:303-253-1614
Mailing Address - Fax:
Practice Address - Street 1:11201 W 107TH PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-3534
Practice Address - Country:US
Practice Address - Phone:303-253-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist