DEBBIE T KHEMMANIVONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049153872

License Status

NOT RENEWED

Business

First Name

DEBBIE

Middle

Last Name

KHEMMANIVONG

Business Name

DEBBIE T KHEMMANIVONG

Original Issue Date

03/24/2004

Effective Date

03/30/2011

Expiration Date

03/31/2012

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/07/2012