STACIE L KETCHAM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049101956

License Status

NOT RENEWED

Business

First Name

STACIE

Middle

Last Name

KETCHAM

Business Name

STACIE L KETCHAM

Original Issue Date

12/10/1992

Effective Date

12/10/1992

Expiration Date

03/31/1994

City

LINCOLN

State

Zip

62656

County

LOGAN

Ever Disciplined

LastModifiedDate

10/17/2005