SUSAN MARIE BAX Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049142735

License Status

NOT RENEWED

Business

First Name

SUSAN

Middle

MARIE

Last Name

BAX

Business Name

SUSAN MARIE BAX

Original Issue Date

05/30/2002

Effective Date

05/30/2002

Expiration Date

03/31/2005

City

EVANSTON

State

Zip

60202

County

COOK

Ever Disciplined

LastModifiedDate

10/20/2005