MALAVONE NACHAMPASSAK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049138086

License Status

NOT RENEWED

Business

First Name

MALAVONE

Last Name

NACHAMPASSAK

Business Name

MALAVONE NACHAMPASSAK

Original Issue Date

09/11/2001

Effective Date

09/11/2001

Expiration Date

03/31/2002

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

12/06/2005