THOMAS HENRY POLAK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049152422

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

HENRY

Last Name

POLAK

Business Name

THOMAS HENRY POLAK

Original Issue Date

12/10/2003

Effective Date

12/10/2003

Expiration Date

03/31/2005

City

ROCKTON

State

Zip

61072

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/20/2005