FARLEN DOUGLAS FORTNER Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049145832

License Status

NOT RENEWED

Business

First Name

FARLEN

Middle

DOUGLAS

Last Name

FORTNER

Business Name

FARLEN DOUGLAS FORTNER

Original Issue Date

11/14/2002

Effective Date

11/14/2002

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60617

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006