KIMBERLY RENEE WALLACE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049131352

License Status

NOT RENEWED

Business

First Name

KIMBERLY

Middle

RENEE

Last Name

WALLACE

Business Name

KIMBERLY RENEE WALLACE

Original Issue Date

06/26/2000

Effective Date

06/26/2000

Expiration Date

03/31/2004

City

SULLIVAN

State

Zip

61951

County

MOULTRIE

Ever Disciplined

LastModifiedDate

10/20/2005