HEATHER A WALLACE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049158691

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

Last Name

WALLACE

Business Name

HEATHER A WALLACE

Original Issue Date

12/30/2004

Effective Date

12/30/2004

Expiration Date

03/31/2006

City

BETHALTO

State

Zip

62010

County

MADISON

Ever Disciplined

LastModifiedDate

05/11/2006