LISA ELLEN PACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

LISA

Middle

ELLEN

Last Name

PACK

Suffix

Business Name

LISA ELLEN PACK MD

Original Issue Date

03/25/2011

Effective Date

03/25/2011

Expiration Date

07/31/2011

City

SPRINGFIELD

State

Zip

07081

County

NEW JERSEY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017