ALFONSO ALLAN BALLEZA II Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049153041

License Status

INACTIVE

Business

First Name

ALFONSO

Middle

ALLAN

Last Name

BALLEZA

Suffix

Business Name

ALFONSO ALLAN BALLEZA II

Original Issue Date

01/29/2004

Effective Date

03/24/2011

Expiration Date

03/31/2012

City

NILES

State

Zip

60714

County

COOK

Ever Disciplined

LastModifiedDate

01/12/2012