LEROY JEROME OTTERNESS Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051027789

License Status

INACTIVE

Business

First Name

LEROY JEROME

Last Name

OTTERNESS

Business Name

LEROY JEROME OTTERNESS

Original Issue Date

01/01/1997

Expiration Date

03/31/2006

City

BOISE

State

Zip

83704

County

IDAHO

Ever Disciplined

LastModifiedDate

01/18/2006