JACQUELINE M CHAMPLAIN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049158310

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Middle

Last Name

CHAMPLAIN

Business Name

JACQUELINE M CHAMPLAIN

Original Issue Date

12/13/2004

Effective Date

12/13/2004

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006