AmerisourceBergen Drug Corpoartion - (Drug Distributor)
William Licciardone, MIC
Salt Lake City, MO 84104
License# : 2002028654 - Issued on : 1/3/2003
Doing Business As : AmerisourceBergen Drug Corporation
| Licensee Name: | AmerisourceBergen Drug Corpoartion |
| Profession Name: | Drug Distributor |
| Licensee Number: | 2002028654 |
| Expiration Date: | 10/31/2017 |
| Original Issue Date: | 1/3/2003 |
| Address: | William Licciardone, MIC |
| Address Con't: | 1765 Fremont Drive |
| City, State Zip: | Salt Lake City, UT 84104 |
| County: | Unknown/Out of State |
| Practitioner DBA Name: | AmerisourceBergen Drug Corporation |
| Classification: | Out of State Wholesale |
| Current Discipline Status: | None |
Board of Pharmacy
3605 Missouri Boulevard
P.O. Box 625
Jefferson City, MO 65102-0625
573.751.0091 Telephone
573.526.3464 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
MissouriBOP@pr.mo.gov
http://pr.mo.gov/pharmacists
