The holder whose full name is Fanning, Lacie Anne,come from Fort Wayne IN,hold the Pharmacy Technician license(NO.67005094A) which status is Expired.
| Name | Fanning, Lacie Anne |
|---|---|
| License Number | 67005094A |
| License Type | Pharmacy Technician |
| License Status | Expired |
| City | Fort Wayne |
| State | IN |