LURA C PROVO Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049063031

License Status

NOT RENEWED

Business

First Name

LURA C

Last Name

PROVO

Business Name

LURA C PROVO

Original Issue Date

02/28/1975

Effective Date

02/28/1975

Expiration Date

01/01/1997

City

NORTHLAKE

State

Zip

60164

County

COOK

Ever Disciplined

LastModifiedDate

10/17/2005