LILLY J RANDOLPH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

NOT RENEWED

Business

First Name

LILLY J

Last Name

RANDOLPH

Suffix

Business Name

LILLY J RANDOLPH MD

Original Issue Date

08/01/1988

Effective Date

08/01/1988

Expiration Date

07/31/1993

City

EAST ST LOUIS

State

Zip

62205

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006