Provider Demographics
NPI:1891077384
Name:ANTONIONI, DINO JOSE (RPH)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:JOSE
Last Name:ANTONIONI
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 1:15115 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3687
Mailing Address - Country:US
Mailing Address - Phone:954-397-1881
Mailing Address - Fax:954-392-8070
Practice Address - Street 1:15115 SW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3687
Practice Address - Country:US
Practice Address - Phone:954-397-1881
Practice Address - Fax:954-392-8070
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist