Licensee Name:KAISER PERMANENTE PHARMACY #168
License Type:LICENSED STERILE COMPOUNDING
License Number:99322
License Status:CLEAR Definition
Expiration Date:November 01, 2015
Issue Date:September 06, 2005
Address:2295 S VINEYARD AVE BASEMENT
City:ONTARIO
State:CA
Zip:91761-7922
County:SAN BERNARDINO
Actions:No
NumberNameTypeStatus
44107LUCK KENNETH AREGISTERED PHARMACISTCLEAR
47112KAISER PERMANENTE PHARMACY #168RETAIL PHARMACYCLEAR

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