LARA MARCELLA MACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****73

License Status

ACTIVE

Business

First Name

LARA

Middle

MARCELLA

Last Name

MACK

Business Name

LARA MARCELLA MACK

Original Issue Date

09/06/2011

Effective Date

12/06/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60611

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/06/2025