MALLORY ANNE ICENOGLE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049153650

License Status

NOT RENEWED

Business

First Name

MALLORY

Middle

ANNE

Last Name

ICENOGLE

Business Name

MALLORY ANNE ICENOGLE

Original Issue Date

03/15/2004

Effective Date

03/28/2011

Expiration Date

03/31/2012

City

BROOKFIELD

State

Zip

60513

County

COOK

Ever Disciplined

LastModifiedDate

05/07/2012