DALE N BERGSTROM Pharmacist License verification

DALE N BERGSTROM

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051024443

License Status

NOT RENEWED

Business

First Name

DALE N

Last Name

BERGSTROM

Business Name

DALE N BERGSTROM

Original Issue Date

01/01/1997

Expiration Date

03/31/1998

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/17/2005

Case Number

1998010987

Action

Suspension

Discipline Start Date

06/23/2000

Discipline Reason

Failed to notify the Department in writing of his departure as a pharmacist-in-charge of Phar-Mor Pharmacy #149 in Rockford and failed to perform a controlled substance inventory prior to his departure.