MANSEL J BROUSSARD Medical Cannabis Professional License verification

Business Entity

TERMINATED

License Type

Medical Cannabis Professional

Description

REGISTERED AGENT

License Number

DOAG230688

License Status

TERMINATED

Business

First Name

MANSEL

Middle

Last Name

BROUSSARD

Business Name

MANSEL J BROUSSARD

Original Issue Date

07/19/2022

Effective Date

07/19/2022

Expiration Date

07/19/2023

City

PEORIA

State

Zip

61606

County

PEORIA

Ever Disciplined

LastModifiedDate

05/04/2023