NITDAVANH ROSE SYPHOMMARATH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049286936

License Status

NOT RENEWED

Business

First Name

NITDAVANH

Middle

ROSE

Last Name

SYPHOMMARATH

Business Name

NITDAVANH ROSE SYPHOMMARATH

Original Issue Date

10/25/2021

Effective Date

04/01/2023

Expiration Date

03/31/2024

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/03/2025