LEROY JEROME OTTERNESS - Pharmacist License in Idaho | # 051027789

LEROY JEROME OTTERNESS

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051027789

License Status

INACTIVE

Business

N

First Name

LEROY JEROME

Last Name

OTTERNESS

Business Name

LEROY JEROME OTTERNESS

Original Issue Date

01/01/1997

Expiration Date

03/31/2006

State

ID

Ever Disciplined

N

LastModifiedDate

01/18/2006