SHANE T BOURGOIS - Pharmacist License in Illinois | # 049167235

SHANE T BOURGOIS

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049167235

License Status

NOT RENEWED

Business

N

First Name

SHANE

Middle

T

Last Name

BOURGOIS

Business Name

SHANE T BOURGOIS

Original Issue Date

04/04/2006

Effective Date

04/04/2006

Expiration Date

03/31/2007

State

IL

Ever Disciplined

N

LastModifiedDate

05/14/2007