HEATHER NICOLE KHAMMANIVONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049189269

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

NICOLE

Last Name

KHAMMANIVONG

Business Name

HEATHER NICOLE KHAMMANIVONG

Original Issue Date

01/21/2009

Effective Date

04/01/2010

Expiration Date

03/31/2011

City

GRANITE CITY

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

05/12/2011