DAVE M PROVIDO Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049148322

License Status

NOT RENEWED

Business

First Name

DAVE

Middle

Last Name

PROVIDO

Business Name

DAVE M PROVIDO

Original Issue Date

04/23/2003

Effective Date

04/01/2010

Expiration Date

03/31/2011

City

FRANKLIN PARK

State

Zip

60131

County

COOK

Ever Disciplined

LastModifiedDate

05/12/2011