MICOLD D`VENITE BLACK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049157096

License Status

NOT RENEWED

Business

First Name

MICOLD

Middle

D`VENITE

Last Name

BLACK

Business Name

MICOLD D`VENITE BLACK

Original Issue Date

09/02/2004

Effective Date

09/02/2004

Expiration Date

03/31/2005

City

CHICAGO

State

Zip

60617

County

COOK

Ever Disciplined

LastModifiedDate

10/20/2005