ANTOINE A BLAKE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049163130

License Status

NOT RENEWED

Business

First Name

ANTOINE

Middle

Last Name

BLAKE

Business Name

ANTOINE A BLAKE

Original Issue Date

08/23/2005

Effective Date

08/23/2005

Expiration Date

03/31/2006

City

BROADVIEW

State

Zip

60155

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006