RAFAEL FORMEZA JR Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049119837

License Status

NOT RENEWED

Business

First Name

RAFAEL

Last Name

FORMEZA

Suffix

Business Name

RAFAEL FORMEZA JR

Original Issue Date

01/13/1998

Effective Date

01/13/2015

Expiration Date

03/31/2016

City

WEST NEW YORK

State

Zip

07093

County

NEW JERSEY

Ever Disciplined

LastModifiedDate

05/20/2016