CHAD A PROVOST Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049167031

License Status

NOT RENEWED

Business

First Name

CHAD

Middle

Last Name

PROVOST

Business Name

CHAD A PROVOST

Original Issue Date

03/27/2006

Effective Date

03/27/2006

Expiration Date

03/31/2007

City

OTTAWA

State

Zip

61350

County

LA SALLE

Ever Disciplined

LastModifiedDate

05/14/2007