KEITH R FUENTES Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049209816

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

FUENTES

Prefix

Business Name

KEITH R FUENTES

Original Issue Date

03/19/2012

Effective Date

02/01/2016

Expiration Date

03/31/2017

City

CHILLICOTHE

State

Zip

61523

County

PEORIA

Ever Disciplined

LastModifiedDate

05/10/2017