SHOPKO PHARMACY 174 Pharmacist License verification

Business Entity

CHANGE OF OWNERSHIP

License Type

Pharmacist

Description

LICENSED PHARMACY

License Number

054014382

License Status

CHANGE OF OWNERSHIP

Business

Business Name

SHOPKO PHARMACY 174

Original Issue Date

08/30/2000

Effective Date

08/30/2000

Expiration Date

03/31/2006

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

05/11/2006