Provider Demographics
NPI:1073893525
Name:SLONE, JONATHAN CLARK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CLARK
Last Name:SLONE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2044
Mailing Address - Country:US
Mailing Address - Phone:770-824-5077
Mailing Address - Fax:770-824-5462
Practice Address - Street 1:201 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2044
Practice Address - Country:US
Practice Address - Phone:770-824-5077
Practice Address - Fax:770-824-5462
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist