BRANDON MICHAEL KHAMMANIVONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049187991

License Status

NOT RENEWED

Business

First Name

BRANDON

Middle

MICHAEL

Last Name

KHAMMANIVONG

Business Name

BRANDON MICHAEL KHAMMANIVONG

Original Issue Date

10/27/2008

Effective Date

08/27/2010

Expiration Date

03/31/2011

City

GRANITE CITY

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

05/12/2011