DIANE RENEE WAGNER Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049175422

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

RENEE

Last Name

WAGNER

Business Name

DIANE RENEE WAGNER

Original Issue Date

04/09/2007

Effective Date

03/19/2013

Expiration Date

03/31/2014

City

SOUTH BELOIT

State

Zip

61080

Ever Disciplined

LastModifiedDate

05/06/2014