NICOLE M ENGHOLM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049152694

License Status

NOT RENEWED

Business

First Name

NICOLE

Middle

Last Name

ENGHOLM

Business Name

NICOLE M ENGHOLM

Original Issue Date

12/23/2003

Effective Date

12/23/2003

Expiration Date

03/31/2005

City

SILVIS

State

Zip

61282

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

10/20/2005