RAIVAN CAMILLE JUNE PETERSON Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049247915

License Status

NOT RENEWED

Business

First Name

RAIVAN

Middle

CAMILLE JUNE

Last Name

PETERSON

Business Name

RAIVAN CAMILLE JUNE PETERSON

Original Issue Date

01/20/2017

Effective Date

03/21/2018

Expiration Date

03/31/2019

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

07/15/2019