MICKENZIE DAWN WADE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049155471

License Status

NOT RENEWED

Business

First Name

MICKENZIE

Middle

DAWN

Last Name

WADE

Business Name

MICKENZIE DAWN WADE

Original Issue Date

06/21/2004

Effective Date

01/10/2008

Expiration Date

03/31/2009

City

CARTERVILLE

State

Zip

62918

County

WILLIAMSON

Ever Disciplined

LastModifiedDate

05/06/2009