NICOLE RENEE WILDE Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049191351

License Status

INACTIVE

Business

First Name

NICOLE

Middle

RENEE

Last Name

WILDE

Business Name

NICOLE RENEE WILDE

Original Issue Date

04/28/2009

Effective Date

02/17/2011

Expiration Date

03/31/2012

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/12/2012