KEITH EDWARD FEDDEMA Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049263193

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

EDWARD

Last Name

FEDDEMA

Business Name

KEITH EDWARD FEDDEMA

Original Issue Date

02/11/2019

Effective Date

01/04/2020

Expiration Date

03/31/2021

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/20/2021