MICKEY BOUNLEUTAY Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049194383

License Status

NOT RENEWED

Business

First Name

MICKEY

Last Name

BOUNLEUTAY

Business Name

MICKEY BOUNLEUTAY

Original Issue Date

09/21/2009

Effective Date

02/08/2011

Expiration Date

03/31/2012

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/07/2012