GRACIE LAFAYE WARREN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049154038

License Status

NOT RENEWED

Business

First Name

GRACIE

Middle

LAFAYE

Last Name

WARREN

Business Name

GRACIE LAFAYE WARREN

Original Issue Date

04/08/2004

Effective Date

04/08/2004

Expiration Date

03/31/2005

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/20/2005