BETHANY K BURGE MD Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049171507

License Status

NOT RENEWED

Business

Title

First Name

BETHANY

Middle

Last Name

BURGE

Business Name

BETHANY K BURGE MD

Original Issue Date

09/20/2006

Effective Date

01/09/2007

Expiration Date

03/31/2008

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/02/2008