CHANTALA KOMMANIVANH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049147638

License Status

NOT RENEWED

Business

First Name

CHANTALA

Last Name

KOMMANIVANH

Business Name

CHANTALA KOMMANIVANH

Original Issue Date

03/27/2003

Effective Date

09/20/2013

Expiration Date

03/31/2014

City

CHICAGO

State

Zip

60630

County

COOK

Ever Disciplined

LastModifiedDate

05/06/2014