BRIAN C FORT MD - Pharmacist License in Illinois | # 049121780

BRIAN C FORT MD

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049121780

License Status

NOT RENEWED

Business

N

Title

MD

First Name

BRIAN

Middle

C

Last Name

FORT

Business Name

BRIAN C FORT MD

Original Issue Date

06/25/1998

Effective Date

06/25/1998

Expiration Date

03/31/2004

State

IL

Ever Disciplined

N

LastModifiedDate

10/20/2005