CHARLES CARMEN PROVENZANO Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049058790

License Status

NOT RENEWED

Business

First Name

CHARLES CARMEN

Last Name

PROVENZANO

Business Name

CHARLES CARMEN PROVENZANO

Original Issue Date

12/06/1972

Effective Date

12/06/1972

Expiration Date

03/31/1992

City

DES PLAINES

State

Zip

60016

County

COOK

Ever Disciplined

LastModifiedDate

10/17/2005