Licensee Name:ELLIS KIMBERLY M
License Type:PHARMACY TECHNICIAN
License Number:52263
License Status:CANCELLED Definition
Expiration Date:November 30, 2009
Issue Date:September 02, 2004
Address:434 W 223RD ST #226
City:CARSON
State:CA
Zip:90745
County:LOS ANGELES
Actions:No
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