LUCHINNI MONTY PRABOWO-MANDAYO Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049267064

License Status

NOT RENEWED

Business

First Name

LUCHINNI

Middle

MONTY

Last Name

PRABOWO-MANDAYO

Business Name

LUCHINNI MONTY PRABOWO-MANDAYO

Original Issue Date

08/02/2019

Effective Date

08/02/2019

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60659

County

COOK

Ever Disciplined

LastModifiedDate

01/08/2021