Licensee Name:KAISER PERMANENTE PHY #193
License Type:LICENSED STERILE COMPOUNDING
License Number:99962
License Status:CLEAR Definition
Expiration Date:November 01, 2015
Issue Date:June 17, 2014
Address:17296 SLOVER AVE, PALM CT I
City:FONTANA
State:CA
Zip:92337-7589
County:SAN BERNARDINO
Actions:No
NumberNameTypeStatus
36695ITO GUY GENREGISTERED PHARMACISTCLEAR
48828KAISER PERMANENTE PHY #193RETAIL PHARMACYCLEAR

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