BRIAN C FORT MD Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049121780

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

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

City

PEKIN

State

Zip

61554

County

TAZEWELL

Ever Disciplined

LastModifiedDate

10/20/2005