GARY L NISSEN Pharmacist License verification

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051029834

License Status

INACTIVE

Business

First Name

GARY L

Last Name

NISSEN

Business Name

GARY L NISSEN

Original Issue Date

12/17/1973

Effective Date

12/17/1973

Expiration Date

03/31/1992

City

MAUSTON

State

Zip

53948

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/17/2005