Indiana
Professional Licensing Agency
Indiana University/Tatiana Y. Kostrominova
Pharmacy Board - Csr
License number
61100663B
Date granted
10/12/2007
Date expires
12/31/2015
Class
Pharmacy Board - Csr
Status
Active
Address
3400 Broadway Street, Gary IN 46408
indianalicensing.org
ID 24877141
LAST UPDATED 2026-05-26 06:15:59 UTC
LAST UPDATED 2026-05-26 06:15:59 UTC
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