AVIVA R SUPPO Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049132205

License Status

NOT RENEWED

Business

First Name

AVIVA

Middle

Last Name

SUPPO

Business Name

AVIVA R SUPPO

Original Issue Date

08/16/2000

Effective Date

08/16/2000

Expiration Date

03/31/2001

City

HIGHLAND PARK

State

Zip

60035

County

LAKE

Ever Disciplined

LastModifiedDate

10/21/2005