TYLER R MICENHEIMER Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049139415

License Status

NOT RENEWED

Business

First Name

TYLER

Middle

Last Name

MICENHEIMER

Business Name

TYLER R MICENHEIMER

Original Issue Date

11/29/2001

Effective Date

11/29/2001

Expiration Date

03/31/2004

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Ever Disciplined

LastModifiedDate

10/20/2005