MARK ALAN FORTMAN Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051031587

License Status

INACTIVE

Business

First Name

MARK ALAN

Last Name

FORTMAN

Business Name

MARK ALAN FORTMAN

Original Issue Date

08/18/1977

Effective Date

02/02/2016

Expiration Date

03/31/2018

City

WESTMONT

State

Zip

60559

County

DUPAGE

Ever Disciplined

LastModifiedDate

01/12/2018