Provider Demographics
NPI:1902619869
Name:ROFAEEL, SAMANTHA SELENA (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SELENA
Last Name:ROFAEEL
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 1:1802 MCDOUGAL WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3685
Mailing Address - Country:US
Mailing Address - Phone:619-277-2962
Mailing Address - Fax:
Practice Address - Street 1:790 JAMACHA RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3201
Practice Address - Country:US
Practice Address - Phone:619-442-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist