SHANNELLE SUSANNE RICO MD - Medical Doctor License in South Dakota | # 33*****72

SHANNELLE SUSANNE RICO MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

CANCELLED

Business

N

First Name

SHANNELLE

Middle

SUSANNE

Last Name

RICO

Suffix

MD

Business Name

SHANNELLE SUSANNE RICO MD

Original Issue Date

09/25/1996

Effective Date

09/25/1996

Expiration Date

07/31/2002

State

SD

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

10/09/2006