BRANDON TYLER BLOM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049247500

License Status

NOT RENEWED

Business

First Name

BRANDON

Middle

TYLER

Last Name

BLOM

Business Name

BRANDON TYLER BLOM

Original Issue Date

01/03/2017

Effective Date

01/03/2017

Expiration Date

03/31/2018

City

RANTOUL

State

Zip

61866

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

06/19/2018