KEO SYSAVANH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049111968

License Status

NOT RENEWED

Business

First Name

KEO

Last Name

SYSAVANH

Business Name

KEO SYSAVANH

Original Issue Date

09/27/1995

Effective Date

09/27/1995

Expiration Date

03/31/1997

City

DEKALB

State

Zip

60115

County

DEKALB

Ever Disciplined

LastModifiedDate

10/17/2005