SHIMEARE M PROVO Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049146343

License Status

NOT RENEWED

Business

First Name

SHIMEARE

Middle

Last Name

PROVO

Business Name

SHIMEARE M PROVO

Original Issue Date

12/13/2002

Effective Date

12/13/2002

Expiration Date

03/31/2004

City

CHICAGO

State

Zip

60636

County

COOK

Ever Disciplined

LastModifiedDate

10/20/2005