Mark A Fortman
InactiveIllinois license 049060519
License
- Licensed by
- Illinois Department of Financial and Professional Regulation
- License number
- 049060519
- Status
- Inactive (Cancelled)
- First issued
- November 2, 1973
- Expired
- January 1, 1997
- License holder
- Mark A Fortman
- Entity type
- Individual
Classifications
- Pharmacy Technician Pharmacy
More from the license record
- Current term began
- 11/02/1973
Contact
Springfield, IL 62702
Sangamon County