Licensee Name:ELLSWORTH ELI DAVID
License Type:PHARMACY TECHNICIAN
License Number:54076
License Status:CLEAR Definition
Expiration Date:July 31, 2015
Issue Date:February 02, 2004
Address:1548 ALTA GLEN DR APT 24
City:SAN JOSE
State:CA
Zip:95125
County:SANTA CLARA
Actions:No
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