BRYAN SCOTT BERGESON Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049156291

License Status

NOT RENEWED

Business

First Name

BRYAN

Middle

SCOTT

Last Name

BERGESON

Business Name

BRYAN SCOTT BERGESON

Original Issue Date

07/29/2004

Effective Date

07/29/2004

Expiration Date

03/31/2006

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/11/2006