KRISTINA SOUKPANYA VONGMOUKDA Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049259029

License Status

NOT RENEWED

Business

First Name

KRISTINA

Middle

SOUKPANYA

Last Name

VONGMOUKDA

Business Name

KRISTINA SOUKPANYA VONGMOUKDA

Original Issue Date

08/08/2018

Effective Date

01/04/2020

Expiration Date

03/31/2021

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/20/2021