SHANTEL L FORMAN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049210975

License Status

NOT RENEWED

Business

First Name

SHANTEL

Middle

Last Name

FORMAN

Business Name

SHANTEL L FORMAN

Original Issue Date

05/11/2012

Effective Date

05/11/2012

Expiration Date

03/31/2013

City

COUNTRY CLUB HILLS

State

Zip

60478

County

COOK

Ever Disciplined

LastModifiedDate

05/06/2013