PHETCHALAD JACKIE SYPHOMMARATH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049187247

License Status

NOT RENEWED

Business

First Name

PHETCHALAD

Middle

JACKIE

Last Name

SYPHOMMARATH

Business Name

PHETCHALAD JACKIE SYPHOMMARATH

Original Issue Date

09/23/2008

Effective Date

03/15/2021

Expiration Date

05/31/2022

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/27/2022