PHILIP AUSTIN FONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049142775

License Status

NOT RENEWED

Business

First Name

PHILIP

Middle

AUSTIN

Last Name

FONG

Business Name

PHILIP AUSTIN FONG

Original Issue Date

05/30/2002

Effective Date

05/30/2002

Expiration Date

03/31/2004

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/20/2005