Licensee Name:MAIN STREET FAMILY PHARMACY LLC
License Type:NONRESIDENT STERILE COMPOUNDING
License Number:99696
License Status:CANCELLED Definition
Expiration Date:December 01, 2013
Issue Date:February 06, 2012
Address:126 E MAIN ST
City:NEWBERN
State:TN
Zip:38059
County:OUT OF STATE
Actions:No
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