DIAN MARIE BAGENT Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049207082

License Status

NOT RENEWED

Business

First Name

DIAN

Middle

MARIE

Last Name

BAGENT

Business Name

DIAN MARIE BAGENT

Original Issue Date

10/03/2011

Effective Date

04/04/2012

Expiration Date

03/31/2013

City

WOOD RIVER

State

Zip

62095

County

MADISON

Ever Disciplined

LastModifiedDate

05/06/2013