TYRONE A LAKE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049215087

License Status

NOT RENEWED

Business

First Name

TYRONE

Middle

Last Name

LAKE

Business Name

TYRONE A LAKE

Original Issue Date

12/19/2012

Effective Date

01/09/2014

Expiration Date

03/31/2015

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/11/2015