DOMINIQUE R WALLACE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049188286

License Status

NOT RENEWED

Business

First Name

DOMINIQUE

Middle

Last Name

WALLACE

Prefix

Business Name

DOMINIQUE R WALLACE

Original Issue Date

11/17/2008

Effective Date

11/17/2008

Expiration Date

03/31/2009

City

CHICAGO

State

Zip

60645

County

COOK

Ever Disciplined

LastModifiedDate

05/06/2009