ETHAN ERIC PETTIWAY Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049145844

License Status

NOT RENEWED

Business

First Name

ETHAN

Middle

ERIC

Last Name

PETTIWAY

Business Name

ETHAN ERIC PETTIWAY

Original Issue Date

11/14/2002

Effective Date

11/14/2002

Expiration Date

03/31/2004

City

CHICAGO

State

Zip

60654

County

COOK

Ever Disciplined

LastModifiedDate

10/20/2005