ANNY T PHORASAVONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049232762

License Status

NOT RENEWED

Business

First Name

ANNY

Middle

Last Name

PHORASAVONG

Prefix

Business Name

ANNY T PHORASAVONG

Original Issue Date

04/30/2015

Effective Date

04/30/2015

Expiration Date

03/31/2016

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/20/2016