STACY LYNN REQUARTH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049130304

License Status

NOT RENEWED

Business

First Name

STACY

Middle

LYNN

Last Name

REQUARTH

Business Name

STACY LYNN REQUARTH

Original Issue Date

03/29/2000

Effective Date

03/29/2000

Expiration Date

03/31/2002

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Ever Disciplined

LastModifiedDate

12/06/2005