SHANE A WYATT Pharmacist License verification

Business Entity

ACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049161763

License Status

ACTIVE

Business

First Name

SHANE

Middle

Last Name

WYATT

Business Name

SHANE A WYATT

Original Issue Date

06/17/2005

Effective Date

03/15/2026

Expiration Date

03/31/2027

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

03/15/2026