KATHLEEN S PROVASI Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049059381

License Status

NOT RENEWED

Business

First Name

KATHLEEN S

Last Name

PROVASI

Business Name

KATHLEEN S PROVASI

Original Issue Date

04/13/1973

Effective Date

02/22/2017

Expiration Date

03/31/2018

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

06/19/2018