KEITH W REQUET Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049105341

License Status

NOT RENEWED

Business

First Name

KEITH W

Last Name

REQUET

Business Name

KEITH W REQUET

Original Issue Date

11/29/1993

Effective Date

11/29/1993

Expiration Date

03/31/1998

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

10/17/2005