FEDAA M BALLOUTA Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049159511

License Status

NOT RENEWED

Business

First Name

FEDAA

Middle

Last Name

BALLOUTA

Business Name

FEDAA M BALLOUTA

Original Issue Date

03/09/2005

Effective Date

02/05/2019

Expiration Date

09/30/2020

City

ORLAND PARK

State

Zip

60462

County

COOK

Ever Disciplined

LastModifiedDate

01/08/2021