LYLE N WAGNER Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051026625

License Status

INACTIVE

Business

First Name

LYLE N

Last Name

WAGNER

Business Name

LYLE N WAGNER

Original Issue Date

01/01/1997

Effective Date

01/17/2012

Expiration Date

03/31/2014

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/09/2014