BOPHA H SAYAVONG Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051041234

License Status

INACTIVE

Business

First Name

BOPHA

Middle

Last Name

SAYAVONG

Business Name

BOPHA H SAYAVONG

Original Issue Date

12/17/1996

Effective Date

02/09/2024

Expiration Date

03/31/2026

City

SANTA ROSA BEACH

State

Zip

32459

Ever Disciplined

LastModifiedDate

02/06/2025