LEROY R BROCKSIECK JR Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049172679

License Status

NOT RENEWED

Business

First Name

LEROY

Middle

Last Name

BROCKSIECK

Suffix

Business Name

LEROY R BROCKSIECK JR

Original Issue Date

11/20/2006

Effective Date

04/07/2011

Expiration Date

03/31/2012

City

MILAN

State

Zip

61264

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

05/07/2012