EDNA NONATO FORMAN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049158411

License Status

NOT RENEWED

Business

First Name

EDNA

Middle

NONATO

Last Name

FORMAN

Business Name

EDNA NONATO FORMAN

Original Issue Date

12/16/2004

Effective Date

01/09/2007

Expiration Date

03/31/2008

City

CHICAGO

State

Zip

60618

County

COOK

Ever Disciplined

LastModifiedDate

05/02/2008