KEITH R BLACKBURN - Pharmacist License in Illinois | # 049154453

KEITH R BLACKBURN

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049154453

License Status

NOT RENEWED

Business

N

First Name

KEITH

Middle

R

Last Name

BLACKBURN

Business Name

KEITH R BLACKBURN

Original Issue Date

05/21/2004

Effective Date

05/21/2004

Expiration Date

03/31/2006

State

IL

Ever Disciplined

N

LastModifiedDate

05/11/2006