BRENNA MARIE FORT Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049268217

License Status

NOT RENEWED

Business

First Name

BRENNA

Middle

MARIE

Last Name

FORT

Business Name

BRENNA MARIE FORT

Original Issue Date

10/03/2019

Effective Date

04/05/2021

Expiration Date

05/31/2022

City

NORTH PEKIN

State

Zip

61554

County

TAZEWELL

Ever Disciplined

LastModifiedDate

07/27/2022