NICKALAUS WT BLACK Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049212627

License Status

NOT RENEWED

Business

First Name

NICKALAUS

Middle

Last Name

BLACK

Prefix

Business Name

NICKALAUS WT BLACK

Original Issue Date

08/02/2012

Effective Date

02/26/2020

Expiration Date

03/31/2021

City

VIENNA

State

Zip

62995

County

WILLIAMSON

Ever Disciplined

LastModifiedDate

07/20/2021