JACOB WILLIAM LONG Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049155229

License Status

NOT RENEWED

Business

First Name

JACOB

Middle

WILLIAM

Last Name

LONG

Business Name

JACOB WILLIAM LONG

Original Issue Date

06/16/2004

Effective Date

06/16/2004

Expiration Date

03/31/2006

City

EWING

State

Zip

62836

County

FRANKLIN

Ever Disciplined

LastModifiedDate

05/11/2006