KIRSTEN E FANTOM Veterinarian License verification

Business Entity

ACTIVE

License Type

Veterinarian

Description

LICENSED VETERINARIAN CONTROLLED SUBSTANCE

License Number

39*****86

License Status

ACTIVE

Business

First Name

KIRSTEN

Middle

Last Name

FANTOM

Business Name

KIRSTEN E FANTOM

Original Issue Date

01/15/2013

Effective Date

01/29/2025

Expiration Date

01/31/2027

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/29/2025