KELLY M GUSTAFSON Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049160015

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

GUSTAFSON

Business Name

KELLY M GUSTAFSON

Original Issue Date

04/08/2005

Effective Date

04/23/2020

Expiration Date

03/31/2021

City

DEKALB

State

Zip

60115

County

DEKALB

Ever Disciplined

LastModifiedDate

07/20/2021