DIANE POLENISIAK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049071008

License Status

NOT RENEWED

Business

First Name

DIANE

Last Name

POLENISIAK

Business Name

DIANE POLENISIAK

Original Issue Date

04/13/1979

Effective Date

04/13/1979

Expiration Date

01/01/1997

City

CHICAGO

State

Zip

60639

County

COOK

Ever Disciplined

LastModifiedDate

10/17/2005