SHANE T BOURGOIS Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049167235

License Status

NOT RENEWED

Business

First Name

SHANE

Middle

Last Name

BOURGOIS

Business Name

SHANE T BOURGOIS

Original Issue Date

04/04/2006

Effective Date

04/04/2006

Expiration Date

03/31/2007

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

05/14/2007