KELLIE N BERGSTROM Pharmacist License verification

Business Entity

NOT RENEWED

License Type

Pharmacist

Description

PHARMACY TECHNICIAN

License Number

049128202

License Status

NOT RENEWED

Business

First Name

KELLIE

Middle

Last Name

BERGSTROM

Business Name

KELLIE N BERGSTROM

Original Issue Date

11/15/1999

Effective Date

01/19/2006

Expiration Date

03/31/2007

City

PELL LAKE

State

Zip

53157

County

WISCONSIN

Ever Disciplined

LastModifiedDate

05/14/2007