SHOPKO PHARMACY 2174 Pharmacist License verification

Business Entity

CHANGE OF OWNERSHIP

License Type

Pharmacist

Description

LICENSED CONTROLLED PHARMACY SUBSTANCE

License Number

32*****23

License Status

CHANGE OF OWNERSHIP

Business

Business Name

SHOPKO PHARMACY 2174

Original Issue Date

03/10/2006

Effective Date

03/10/2006

Expiration Date

03/31/2008

City

PEORIA

State

Zip

61615

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/04/2006