LISA M FORTMAN Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051035952

License Status

INACTIVE

Business

First Name

LISA

Middle

Last Name

FORTMAN

Business Name

LISA M FORTMAN

Original Issue Date

09/27/1985

Effective Date

09/27/1985

Expiration Date

03/31/1990

City

HINSDALE

State

Zip

60521

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/17/2005