DIANNE GERISE POLK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049109804

License Status

NOT RENEWED

Business

First Name

DIANNE GERISE

Last Name

POLK

Business Name

DIANNE GERISE POLK

Original Issue Date

03/13/1995

Effective Date

03/13/1995

Expiration Date

03/31/1998

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/17/2005