GERALD H FAGEN Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051038288

License Status

NOT RENEWED

Business

First Name

GERALD H

Last Name

FAGEN

Business Name

GERALD H FAGEN

Original Issue Date

06/12/1991

Effective Date

06/12/1991

Expiration Date

03/31/1994

City

DEMOTTE

State

Zip

46310

County

INDIANA

Ever Disciplined

LastModifiedDate

10/17/2005