MARK A FORTMAN Pharmacist License verification

Business Entity

CANCELLED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049060519

License Status

CANCELLED

Business

First Name

MARK A

Last Name

FORTMAN

Business Name

MARK A FORTMAN

Original Issue Date

11/02/1973

Effective Date

11/02/1973

Expiration Date

01/01/1997

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/17/2005