PROVIDENT MEDICAL CTR DEPT OF PHARMA Pharmacist License verification

Business Entity

CLOSED

License Type

Pharmacist

Description

LICENSED CONTROLLED PHARMACY SUBSTANCE

License Number

32*****05

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

Specialty/Qualifier

Hospital/Clinic

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/18/2005