SHANTEL L FORMAN - Pharmacist License in Illinois | # 049210975

SHANTEL L FORMAN

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049210975

License Status

NOT RENEWED

Business

N

First Name

SHANTEL

Middle

L

Last Name

FORMAN

Business Name

SHANTEL L FORMAN

Original Issue Date

05/11/2012

Effective Date

05/11/2012

Expiration Date

03/31/2013

State

IL

Ever Disciplined

N

LastModifiedDate

05/06/2013