STACEY RENAE NIEHAUS Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049147707

License Status

NOT RENEWED

Business

First Name

STACEY

Middle

RENAE

Last Name

NIEHAUS

Business Name

STACEY RENAE NIEHAUS

Original Issue Date

03/31/2003

Effective Date

03/31/2003

Expiration Date

03/31/2004

City

SPRINGFIELD

State

Zip

62707

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/20/2005