MALLERY E BLACK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049156477

License Status

NOT RENEWED

Business

First Name

MALLERY

Middle

Last Name

BLACK

Business Name

MALLERY E BLACK

Original Issue Date

08/10/2004

Effective Date

08/10/2004

Expiration Date

03/31/2005

City

WEST DUNDEE

State

Zip

60118

County

COOK

Ever Disciplined

LastModifiedDate

10/20/2005