MARY ANN FORTAE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049073030

License Status

NOT RENEWED

Business

First Name

MARY ANN

Last Name

FORTAE

Business Name

MARY ANN FORTAE

Original Issue Date

05/30/1980

Effective Date

05/30/1980

Expiration Date

03/31/1982

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Ever Disciplined

LastModifiedDate

10/17/2005