GENOA HEALTHCARE OF ILLINOIS LLC Pharmacist License verification

Business Entity

CHANGE OF OWNERSHIP

License Type

Pharmacist

Description

LICENSED CONTROLLED PHARMACY SUBSTANCE

License Number

32*****21

License Status

CHANGE OF OWNERSHIP

Business

Business Name

GENOA HEALTHCARE OF ILLINOIS LLC

Original Issue Date

02/23/2012

Effective Date

01/24/2014

Expiration Date

03/31/2016

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

RETAIL PHARMACY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/14/2011