NICOLE R BURLEYSON Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049123076

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

BURLEYSON

Business Name

NICOLE R BURLEYSON

Original Issue Date

10/05/1998

Effective Date

10/05/1998

Expiration Date

03/31/2005

City

CENTRALIA

State

Zip

62801

County

MARION

Ever Disciplined

LastModifiedDate

10/20/2005