PHAYBOUN K KATTAVIRAVONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049143232

License Status

NOT RENEWED

Business

First Name

PHAYBOUN

Middle

Last Name

KATTAVIRAVONG

Business Name

PHAYBOUN K KATTAVIRAVONG

Original Issue Date

06/17/2002

Effective Date

06/17/2002

Expiration Date

03/31/2003

City

ROMEOVILLE

State

Zip

60446

County

WILL

Ever Disciplined

LastModifiedDate

10/20/2005