STACY RENEE TIDWELL Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049161291

License Status

NOT RENEWED

Business

First Name

STACY

Middle

RENEE

Last Name

TIDWELL

Business Name

STACY RENEE TIDWELL

Original Issue Date

05/24/2005

Effective Date

05/24/2005

Expiration Date

03/31/2006

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

05/11/2006