LAVONTAINE T WIRTH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049220679

License Status

NOT RENEWED

Business

First Name

LAVONTAINE

Middle

Last Name

WIRTH

Prefix

Business Name

LAVONTAINE T WIRTH

Original Issue Date

09/09/2013

Effective Date

03/11/2014

Expiration Date

03/31/2015

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Ever Disciplined

LastModifiedDate

05/11/2015