Mallory J Provstgaard
Pharmacy in Lake Shore, UT

License number
Utah 8412718-1722
Issued Date
Aug 17, 2012
Expiration Date
Aug 17, 2014
Category
Pharmacy
Type
Approval for Pharmacy Tech Training
Address
Address
Lake Shore, UT
Education
MOUNTAINLAND ATC, Jul 30, 2013
LicenseFiles verified this license of Dec 7, 2016 at the Utah Division of Occupational and Professional Licensing.

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