SHOPKO INSTITUTIONAL CARE SERVICES CO LLC Pharmacist License verification

Business Entity

CHANGE OF OWNERSHIP

License Type

Pharmacist

Description

LICENSED CONTROLLED PHARMACY SUBSTANCE

License Number

32*****76

License Status

CHANGE OF OWNERSHIP

Business

Business Name

SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

Original Issue Date

04/05/2011

Effective Date

01/28/2014

Expiration Date

03/31/2016

City

BROOKFIELD

State

Zip

53045

County

WISCONSIN

Specialty/Qualifier

RETAIL PHARMACY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/14/2013