PHILIP A WALLEN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049143193

License Status

NOT RENEWED

Business

First Name

PHILIP

Middle

Last Name

WALLEN

Business Name

PHILIP A WALLEN

Original Issue Date

06/13/2002

Effective Date

06/13/2002

Expiration Date

03/31/2003

City

BEASON

State

Zip

62512

County

LOGAN

Ever Disciplined

LastModifiedDate

10/20/2005