PROVIDENT MEDICAL CTR DEPT OF PHARMA - Pharmacist License in Illinois | # 059003331

PROVIDENT MEDICAL CTR DEPT OF PHARMA

Business Entity

CLOSED

License Type

Pharmacist

Description

LICENSED DIVISION III PHARMACY

License Number

059003331

License Status

CLOSED

Business

Y

Business Name

PROVIDENT MEDICAL CTR DEPT OF PHARMA

Original Issue Date

01/01/1997

Expiration Date

03/31/1988

State

IL

Ever Disciplined

N

LastModifiedDate

10/19/2005