TRISTA L BLACK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049114766

License Status

NOT RENEWED

Business

First Name

TRISTA L

Last Name

BLACK

Business Name

TRISTA L BLACK

Original Issue Date

08/01/1996

Effective Date

08/01/1996

Expiration Date

03/31/2000

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Ever Disciplined

LastModifiedDate

10/21/2005