Provider Demographics
NPI:1215160023
Name:SCAFETTA, ANDREA NICOLE II
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:NICOLE
Last Name:SCAFETTA
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 S JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-5247
Mailing Address - Country:US
Mailing Address - Phone:215-755-0435
Mailing Address - Fax:
Practice Address - Street 1:1 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2017
Practice Address - Country:US
Practice Address - Phone:215-463-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist