DALTON P DIECKOW Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049223861

License Status

NOT RENEWED

Business

First Name

DALTON

Middle

Last Name

DIECKOW

Prefix

Business Name

DALTON P DIECKOW

Original Issue Date

03/12/2014

Effective Date

02/22/2020

Expiration Date

03/31/2021

City

MAPLETON

State

Zip

61547

County

PEORIA

Ever Disciplined

LastModifiedDate

07/20/2021