Provider Demographics
NPI:1679856454
Name:AFTEWICZ, HENRY JR
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:AFTEWICZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2585
Mailing Address - Country:US
Mailing Address - Phone:570-341-1429
Mailing Address - Fax:570-343-1494
Practice Address - Street 1:330 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2585
Practice Address - Country:US
Practice Address - Phone:570-341-1429
Practice Address - Fax:570-343-1494
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045786L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist