ANNA LATSAMY PHIDARAT Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049181074

License Status

NOT RENEWED

Business

First Name

ANNA

Middle

LATSAMY

Last Name

PHIDARAT

Business Name

ANNA LATSAMY PHIDARAT

Original Issue Date

12/11/2007

Effective Date

01/10/2008

Expiration Date

03/31/2009

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/06/2009