ANNIE JULIA SUPPLE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049154534

License Status

NOT RENEWED

Business

First Name

ANNIE

Middle

JULIA

Last Name

SUPPLE

Business Name

ANNIE JULIA SUPPLE

Original Issue Date

05/21/2004

Effective Date

05/21/2004

Expiration Date

03/31/2005

City

MORTON

State

Zip

61550

County

TAZEWELL

Ever Disciplined

LastModifiedDate

10/20/2005