MATTHEW ROSS LARSON Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049145701

License Status

INACTIVE

Business

First Name

MATTHEW

Middle

ROSS

Last Name

LARSON

Business Name

MATTHEW ROSS LARSON

Original Issue Date

11/06/2002

Effective Date

01/19/2010

Expiration Date

03/31/2011

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/05/2011