KEITH EDWARD BALLINGER Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049122904

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

EDWARD

Last Name

BALLINGER

Business Name

KEITH EDWARD BALLINGER

Original Issue Date

09/25/1998

Effective Date

09/25/1998

Expiration Date

03/31/2003

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

10/20/2005