JACOB SCOTT CLARK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049196011

License Status

NOT RENEWED

Business

First Name

JACOB

Middle

SCOTT

Last Name

CLARK

Business Name

JACOB SCOTT CLARK

Original Issue Date

12/29/2009

Effective Date

11/16/2011

Expiration Date

03/31/2012

City

PERU

State

Zip

61354

County

LA SALLE

Ever Disciplined

LastModifiedDate

05/07/2012