SIRILAK BOUTTAVONG - Pharmacist License in Illinois | # 049179824

SIRILAK BOUTTAVONG

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049179824

License Status

NOT RENEWED

Business

N

First Name

SIRILAK

Last Name

BOUTTAVONG

Business Name

SIRILAK BOUTTAVONG

Original Issue Date

10/09/2007

Effective Date

10/09/2007

Expiration Date

03/31/2008

State

IL

Ever Disciplined

N

LastModifiedDate

05/02/2008