PROVIDENT MEDICAL CTR DEPT OF PHARMA Pharmacist License verification

Business Entity

CLOSED

License Type

Pharmacist

Description

LICENSED DIVISION III PHARMACY

License Number

059003331

License Status

CLOSED

Business

Business Name

PROVIDENT MEDICAL CTR DEPT OF PHARMA

Original Issue Date

01/01/1997

Expiration Date

03/31/1988

City

CHICAGO

State

Zip

60615

County

COOK

Ever Disciplined

LastModifiedDate

10/19/2005