DEREK DANIEL PELATE Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049154891

License Status

INACTIVE

Business

First Name

DEREK

Middle

DANIEL

Last Name

PELATE

Business Name

DEREK DANIEL PELATE

Original Issue Date

06/10/2004

Effective Date

01/09/2007

Expiration Date

03/31/2008

City

MARYVILLE

State

Zip

62062

County

MADISON

Ever Disciplined

LastModifiedDate

01/10/2008