Pharmacist

LICENSED CONTROLLED PHARMACY SUBSTANCE

32*****42

NOT RENEWED

Y

PRESCRIPTION MART

07/15/1981

07/15/1981

03/31/2000

CHICAGO

IL

60619

COOK

Hospital/Clinic

II III IV V

Y

10/20/2005

1989004516

Probation

06/15/1990

12/15/1990