NICHOLAS STEVE BRUKETTA Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049059575

License Status

NOT RENEWED

Business

First Name

NICHOLAS STEVE

Last Name

BRUKETTA

Business Name

NICHOLAS STEVE BRUKETTA

Original Issue Date

06/01/1973

Effective Date

06/01/1973

Expiration Date

01/01/1997

City

TABLE GROVE

State

Zip

61482

County

FULTON

Ever Disciplined

LastModifiedDate

10/17/2005