GARY T WALLBAUM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049101837

License Status

NOT RENEWED

Business

First Name

GARY T

Last Name

WALLBAUM

Business Name

GARY T WALLBAUM

Original Issue Date

11/24/1992

Effective Date

03/31/2009

Expiration Date

03/31/2010

City

OTTAWA

State

Zip

61350

County

LA SALLE

Ever Disciplined

LastModifiedDate

05/04/2010