KELLY DIANE SMITH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049073602

License Status

NOT RENEWED

Business

First Name

KELLY DIANE

Last Name

SMITH

Business Name

KELLY DIANE SMITH

Original Issue Date

09/19/1980

Effective Date

09/19/1980

Expiration Date

03/31/1984

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/17/2005