TIFFANY ANNE LANE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049165122

License Status

NOT RENEWED

Business

First Name

TIFFANY

Middle

ANNE

Last Name

LANE

Business Name

TIFFANY ANNE LANE

Original Issue Date

11/21/2005

Effective Date

01/19/2006

Expiration Date

03/31/2007

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/14/2007