Provider Demographics
NPI:1659989259
Name:ANTONE, JABARI HARVEY (RPH)
Entity Type:Individual
Prefix:DR
First Name:JABARI
Middle Name:HARVEY
Last Name:ANTONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9688 CONCORD PL
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-7468
Mailing Address - Country:US
Mailing Address - Phone:251-490-1288
Mailing Address - Fax:
Practice Address - Street 1:12 SHELTON BEACH RD
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2403
Practice Address - Country:US
Practice Address - Phone:251-675-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist