License Number: PH17377

Data As Of 11/14/2018

Profession Pharmacy
License PH17377
License Status CLEAR/
Qualifications Community Pharmacy Schedule II & III
License Expiration Date 2/28/2019
License Original Issue Date 07/11/2000
Address of Record 501 N. BENEVA ROAD
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain) No
Discipline on File No
Public Complaint No

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