SHANNELLE SUSANNE RICO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

CANCELLED

Business

First Name

SHANNELLE

Middle

SUSANNE

Last Name

RICO

Suffix

Business Name

SHANNELLE SUSANNE RICO MD

Original Issue Date

09/25/1996

Effective Date

09/25/1996

Expiration Date

07/31/2002

City

RAPID CITY

State

Zip

57701

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006