ILLINOIS SUPER FOODS INC Pharmacist License verification

ILLINOIS SUPER FOODS INC

Business Entity

CHANGE OF OWNERSHIP

License Type

Pharmacist

Description

LICENSED CONTROLLED PHARMACY SUBSTANCE

License Number

32*****50

License Status

CHANGE OF OWNERSHIP

Business

Business Name

ILLINOIS SUPER FOODS INC

Original Issue Date

09/04/1996

Effective Date

09/04/1996

Expiration Date

03/31/2000

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

Hospital/Clinic

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/18/2005

Case Number

1997050250

Action

Probation

Discipline Start Date

01/17/1999

Discipline End Date

01/16/2001

Discipline Reason

A Department audit revealed substancial discrepancies in certain controlled substances and a pharmacy employee diverted controlled substances and the pharmacy owners failed to adequately secure the pharmacy's controlled substances.