TABITHA M KELLY Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049157794

License Status

NOT RENEWED

Business

First Name

TABITHA

Middle

Last Name

KELLY

Business Name

TABITHA M KELLY

Original Issue Date

11/09/2004

Effective Date

11/09/2004

Expiration Date

03/31/2005

City

WOOD RIVER

State

Zip

62095

County

MADISON

Ever Disciplined

LastModifiedDate

10/20/2005