LISA ANN FORMAN DVM Veterinarian License verification

Business Entity

NOT RENEWED

License Type

Veterinarian

Description

LICENSED VETERINARIAN CONTROLLED SUBSTANCE

License Number

39*****64

License Status

NOT RENEWED

Business

First Name

LISA

Middle

ANN

Last Name

FORMAN

Suffix

DVM

Business Name

LISA ANN FORMAN DVM

Original Issue Date

02/25/2002

Effective Date

11/19/2018

Expiration Date

01/31/2021

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/11/2021