STACEY LOU WALLACE Pharmacist License verification

STACEY LOU WALLACE

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049142004

License Status

NOT RENEWED

Business

First Name

STACEY

Middle

LOU

Last Name

WALLACE

Business Name

STACEY LOU WALLACE

Original Issue Date

04/24/2002

Effective Date

01/30/2009

Expiration Date

03/31/2010

City

HAVANA

State

Zip

62644

County

MASON

Ever Disciplined

LastModifiedDate

08/10/2010

Case Number

2010001778

Action

Refuse To Renew

Discipline Start Date

08/10/2010

Discipline Reason

for forging prescriptions for the purpose of causing controlled substances to be dispensed to another individual over a period of approximately two years.