RAVEN L WALLACE - Pharmacist License in Illinois | # 049202013

RAVEN L WALLACE

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049202013

License Status

NOT RENEWED

Business

N

First Name

RAVEN

Middle

L

Last Name

WALLACE

Prefix

MR

Business Name

RAVEN L WALLACE

Original Issue Date

12/18/2010

Effective Date

12/18/2010

Expiration Date

03/31/2011

State

IL

Ever Disciplined

N

LastModifiedDate

05/12/2011