DIRK ANTHONY MOORE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049154640

License Status

NOT RENEWED

Business

First Name

DIRK

Middle

ANTHONY

Last Name

MOORE

Business Name

DIRK ANTHONY MOORE

Original Issue Date

05/28/2004

Effective Date

05/28/2004

Expiration Date

03/31/2005

City

ROUND LAKE

State

Zip

60073

County

LAKE

Ever Disciplined

LastModifiedDate

10/20/2005