KELLY A WIESE Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049122572

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

WIESE

Business Name

KELLY A WIESE

Original Issue Date

08/25/1998

Effective Date

08/25/1998

Expiration Date

03/31/2002

City

LAKE GENEVA

State

Zip

53147

County

WISCONSIN

Ever Disciplined

LastModifiedDate

12/06/2005