DAVID KENYON MONTGOMERY Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051031232

License Status

INACTIVE

Business

First Name

DAVID

Middle

KENYON

Last Name

MONTGOMERY

Business Name

DAVID KENYON MONTGOMERY

Original Issue Date

11/03/1976

Effective Date

03/16/2010

Expiration Date

03/31/2012

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/12/2012