WILLIAM R PROVENCE Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049160780

License Status

INACTIVE

Business

First Name

WILLIAM

Middle

Last Name

PROVENCE

Business Name

WILLIAM R PROVENCE

Original Issue Date

05/04/2005

Effective Date

01/25/2011

Expiration Date

03/31/2012

City

DWIGHT

State

Zip

60420

County

LIVINGSTON

Ever Disciplined

LastModifiedDate

03/14/2012