DAX E FUITEN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049106973

License Status

NOT RENEWED

Business

First Name

DAX

Middle

Last Name

FUITEN

Business Name

DAX E FUITEN

Original Issue Date

05/20/1994

Effective Date

05/20/1994

Expiration Date

03/31/1998

City

SHERMAN

State

Zip

62684

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/17/2005