Charles Carmen Provenzano
ExpiredIllinois license 049058790
License
- Licensed by
- Illinois Department of Financial and Professional Regulation
- License number
- 049058790
- Status
- Expired (Not Renewed)
- First issued
- December 6, 1972
- Expired
- March 31, 1992
- License holder
- Charles Carmen Provenzano
- Entity type
- Individual
Classifications
- Pharmacy Technician Pharmacy
More from the license record
- Current term began
- 12/06/1972
Contact
Des Plaines, IL 60016
Cook County