THOMAS MARTIN WALLACE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049132253

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

MARTIN

Last Name

WALLACE

Business Name

THOMAS MARTIN WALLACE

Original Issue Date

08/17/2000

Effective Date

08/17/2000

Expiration Date

03/31/2002

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

12/06/2005