The holder whose full name is CHAMP, MATTHEW ALAN,come from LUCERNE IN,hold the Pharmacy Intern license(NO.45009488A) which status is Expired.
| Name | CHAMP, MATTHEW ALAN |
|---|---|
| License Number | 45009488A |
| License Type | Pharmacy Intern |
| License Status | Expired |
| City | LUCERNE |
| State | IN |