NICK WILLIAM FULTAN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049152908

License Status

NOT RENEWED

Business

First Name

NICK

Middle

WILLIAM

Last Name

FULTAN

Business Name

NICK WILLIAM FULTAN

Original Issue Date

01/16/2004

Effective Date

01/16/2004

Expiration Date

03/31/2005

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/20/2005