SAMUEL G FOUNTAIN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049190422

License Status

NOT RENEWED

Business

First Name

SAMUEL

Middle

Last Name

FOUNTAIN

Prefix

Business Name

SAMUEL G FOUNTAIN

Original Issue Date

03/23/2009

Effective Date

03/23/2009

Expiration Date

03/31/2010

City

POPLAR GROVE

State

Zip

61065

County

BOONE

Ever Disciplined

LastModifiedDate

05/04/2010