LARRY WAHLSTROM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049064438

License Status

NOT RENEWED

Business

First Name

LARRY

Last Name

WAHLSTROM

Business Name

LARRY WAHLSTROM

Original Issue Date

10/31/1975

Effective Date

10/31/1975

Expiration Date

01/01/1997

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/17/2005