AmerisourceBergen Drug Corp - (Drug Distributor)
John Bridger Tatum, MIC
Roanoke, MO 76262
License# : 2005002742 - Issued on : 2/3/2005
Doing Business As : AmerisourceBergen Drug Corp
| Licensee Name: | AmerisourceBergen Drug Corp |
| Profession Name: | Drug Distributor |
| Licensee Number: | 2005002742 |
| Expiration Date: | 10/31/2015 |
| Original Issue Date: | 2/3/2005 |
| Address: | John Bridger Tatum, MIC |
| Address Con't: | 501 Patriot Parkway |
| City, State Zip: | Roanoke, TX 76262 |
| County: | Unknown/Out of State |
| Practitioner DBA Name: | AmerisourceBergen Drug Corp |
| 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
