PHYLLIS ELAINE CLARK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049149156

License Status

NOT RENEWED

Business

First Name

PHYLLIS

Middle

ELAINE

Last Name

CLARK

Business Name

PHYLLIS ELAINE CLARK

Original Issue Date

06/24/2003

Effective Date

01/17/2013

Expiration Date

03/31/2014

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/06/2014