NATHAN MARSHALL STATUM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049163574

License Status

NOT RENEWED

Business

First Name

NATHAN

Middle

MARSHALL

Last Name

STATUM

Business Name

NATHAN MARSHALL STATUM

Original Issue Date

09/07/2005

Effective Date

09/07/2005

Expiration Date

03/31/2006

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/11/2006