IL DEPT OF PUBLIC HEALTH Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

OTHER CONTROLLED SUBSTANCE

License Number

097000776

License Status

NOT RENEWED

Business

Business Name

IL DEPT OF PUBLIC HEALTH

Original Issue Date

06/05/1991

Effective Date

10/23/2014

Expiration Date

12/31/2016

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

GOVT-STATE

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

02/17/2017