MATTHEW W BLOOM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049114793

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

Last Name

BLOOM

Business Name

MATTHEW W BLOOM

Original Issue Date

08/03/1996

Effective Date

08/03/1996

Expiration Date

03/31/2000

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

10/21/2005