SOURATHDA ASJAH SYPHOMMARATH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049252724

License Status

NOT RENEWED

Business

First Name

SOURATHDA

Middle

ASJAH

Last Name

SYPHOMMARATH

Business Name

SOURATHDA ASJAH SYPHOMMARATH

Original Issue Date

09/06/2017

Effective Date

03/23/2018

Expiration Date

03/31/2019

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/15/2019