KEITH R BLACKBURN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049154453

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

BLACKBURN

Business Name

KEITH R BLACKBURN

Original Issue Date

05/21/2004

Effective Date

05/21/2004

Expiration Date

03/31/2006

City

GRAYS LAKE

State

Zip

60030

County

LAKE

Ever Disciplined

LastModifiedDate

05/11/2006