DETAVIS VONTE DERRICKSON Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049272192

License Status

NOT RENEWED

Business

First Name

DETAVIS

Middle

VONTE

Last Name

DERRICKSON

Business Name

DETAVIS VONTE DERRICKSON

Original Issue Date

04/01/2020

Effective Date

04/01/2020

Expiration Date

03/31/2021

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

07/20/2021