DETAVIS VONTE DERRICKSON - Pharmacist License in Illinois | # 049272192

DETAVIS VONTE DERRICKSON

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049272192

License Status

NOT RENEWED

Business

N

First Name

DETAVIS

Middle

VONTE

Last Name

DERRICKSON

Business Name

DETAVIS VONTE DERRICKSON

Original Issue Date

04/01/2020

Effective Date

04/01/2020

Expiration Date

03/31/2021

State

IL

Ever Disciplined

N

LastModifiedDate

07/20/2021