TRAVIS DONALD MICKELSON Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049144640

License Status

NOT RENEWED

Business

First Name

TRAVIS

Middle

DONALD

Last Name

MICKELSON

Business Name

TRAVIS DONALD MICKELSON

Original Issue Date

09/13/2002

Effective Date

01/19/2006

Expiration Date

03/31/2007

City

APPLE VALLEY

State

Zip

55124

County

MINNESOTA

Ever Disciplined

LastModifiedDate

05/14/2007