JERRY M DE BRUIN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051039656

License Status

NOT RENEWED

Business

First Name

JERRY M

Last Name

DE BRUIN

Business Name

JERRY M DE BRUIN

Original Issue Date

01/14/1994

Effective Date

01/14/1994

Expiration Date

03/31/1996

City

PHOENIX

State

Zip

85054

County

ARIZONA

Ever Disciplined

LastModifiedDate

10/17/2005