The holder whose full name is Fields, Derek Brent,come from Bloomington IN,hold the Pharmacy Intern license(NO.45012153A) which status is Superceded.
| Name | Fields, Derek Brent |
|---|---|
| License Number | 45012153A |
| License Type | Pharmacy Intern |
| License Status | Superceded |
| City | Bloomington |
| State | IN |