Licensee Name:MULE CREEK STATE PRISON PHARMACY
License Type:LICENSED CORRECTIONAL FACILITY (FEE EXEMPT)
License Number:35817
License Status:CLEAR Definition
Expiration Date:November 01, 2015
Issue Date:October 25, 1989
Address:4001 HWY 104/P O BOX 409099
City:IONE
State:CA
Zip:95640
County:AMADOR
Actions:No
NumberNameTypeStatus
57600NDAMUKONG MOURINE NAHFOKREGISTERED PHARMACISTCLEAR

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