Licensee Name:KAISER PERMANENTE PHRMCY #251
License Type:LICENSED STERILE COMPOUNDING
License Number:99963
License Status:CANCELLED Definition
Expiration Date:August 01, 2014
Issue Date:June 09, 2014
Address:13652 CANTARA ST 2ND FLR #214
City:PANORAMA CITY
State:CA
Zip:91402-5423
County:LOS ANGELES
Actions:No
NumberNameTypeStatus
42715MADRAZO GLENN MELVYNREGISTERED PHARMACISTCLEAR
43673JAMGOTCHIAN DIANAREGISTERED PHARMACISTCLEAR
48948KAISER PERMANENTE PHRMCY #251RETAIL PHARMACYCANCELLED

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