KELISSA PETERSON DMD Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049211727

License Status

INACTIVE

Business

Title

DMD

First Name

KELISSA

Last Name

PETERSON

Business Name

KELISSA PETERSON DMD

Original Issue Date

06/17/2012

Effective Date

02/13/2015

Expiration Date

03/31/2016

City

SHERIDAN

State

Zip

60551

County

LA SALLE

Ever Disciplined

LastModifiedDate

01/28/2016