ALYSA MICHELLE WAGNER Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049137049

License Status

NOT RENEWED

Business

First Name

ALYSA

Middle

MICHELLE

Last Name

WAGNER

Business Name

ALYSA MICHELLE WAGNER

Original Issue Date

07/03/2001

Effective Date

01/09/2007

Expiration Date

03/31/2008

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Ever Disciplined

LastModifiedDate

05/02/2008