MIRANDA WALLACE Veterinarian License verification

Business Entity

NOT RENEWED

License Type

Veterinarian

Description

LICENSED VETERINARIAN CONTROLLED SUBSTANCE

License Number

39*****73

License Status

NOT RENEWED

Business

First Name

MIRANDA

Last Name

WALLACE

Business Name

MIRANDA WALLACE

Original Issue Date

07/14/2021

Effective Date

11/08/2022

Expiration Date

02/28/2025

City

LA SALLE

State

Zip

61301

County

LA SALLE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/09/2025