TONI ANN MARIA FORNWALT Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049195318

License Status

INACTIVE

Business

First Name

TONI

Middle

ANN MARIA

Last Name

FORNWALT

Business Name

TONI ANN MARIA FORNWALT

Original Issue Date

11/13/2009

Effective Date

11/13/2009

Expiration Date

03/31/2010

City

MOUNT CARMEL

State

Zip

62863

County

WABASH

Ever Disciplined

LastModifiedDate

01/12/2010