MICHAEL PAUL FORMELLA Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049121351

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

PAUL

Last Name

FORMELLA

Business Name

MICHAEL PAUL FORMELLA

Original Issue Date

06/08/1998

Effective Date

06/08/1998

Expiration Date

03/31/1999

City

ORLAND PARK

State

Zip

60462

County

COOK

Ever Disciplined

LastModifiedDate

10/17/2005