TANJA R WIERSUM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049113274

License Status

NOT RENEWED

Business

First Name

TANJA

Middle

Last Name

WIERSUM

Business Name

TANJA R WIERSUM

Original Issue Date

02/01/1996

Effective Date

02/01/1996

Expiration Date

03/31/2003

City

BARRINGTON

State

Zip

60010

County

LAKE

Ever Disciplined

LastModifiedDate

10/20/2005