DAVID LEE GORTAT - Pharmacist License in Indiana | # 051029998

DAVID LEE GORTAT

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051029998

License Status

INACTIVE

Business

N

First Name

DAVID LEE

Last Name

GORTAT

Business Name

DAVID LEE GORTAT

Original Issue Date

08/02/1974

Effective Date

03/31/2004

Expiration Date

03/31/2006

State

IN

Ever Disciplined

N

LastModifiedDate

01/18/2006