DAVID DIEDERICH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049061741

License Status

NOT RENEWED

Business

First Name

DAVID

Last Name

DIEDERICH

Business Name

DAVID DIEDERICH

Original Issue Date

06/21/1974

Effective Date

06/21/1974

Expiration Date

01/01/1997

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/17/2005