ANTHONY A PROVENZANO Pharmacist License verification

Business Entity

ACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051038900

License Status

ACTIVE

Business

First Name

ANTHONY A

Last Name

PROVENZANO

Business Name

ANTHONY A PROVENZANO

Original Issue Date

08/11/1992

Effective Date

02/15/2026

Expiration Date

03/31/2028

City

BOISE

State

Zip

83706

County

IDAHO

Ever Disciplined

LastModifiedDate

02/15/2026