KEITH DAVID CLANCY (Credential# 1444100) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
KEITH DAVID CLANCY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0066642. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 7900 West Jefferson Blvd, Fort Wayne, IN 46804. The current status is active.
| Licensee Name | KEITH DAVID CLANCY |
| Credential ID | 1444100 |
| Credential Number | CSP.0066642 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
7900 West Jefferson Blvd Fort Wayne IN 46804 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2017-08-22 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-02-05 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1432094 | 1.056908 | Physician/Surgeon | 2017-08-18 | 2019-06-01 - 2020-05-31 | ACTIVE |
| Street Address | 7900 West Jefferson Blvd |
| City | Fort Wayne |
| State | IN |
| Zip Code | 46804 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Sco Engineering LLC | 6534 Constitution Drive, Fort Wayne, IN 46804 | Professional Engineering Corporation | 2020-06-24 ~ 2021-06-12 |
| Summit Outdoors LLC | 6714 Pointe Inverness Way, Fort Wayne, IN 46804 | Importer of Bedding & Upholstered Furniture | 2020-05-01 ~ 2021-04-30 |
| Ralph G Fetter Jr · Hamilton Standard | 7529 Amber Rd, Fort Wayne, IN 46804 | Professional Engineer | 1989-03-02 ~ 1990-01-31 |
| Jerry L Thompson | 3423 St. Alban Court, Fort Wayne, IN 46804 | Professional Engineer | 2003-02-01 ~ 2004-01-31 |
| Marta E Wrobleski | 2423 Lake Ridge Dr, Fort Wayne, IN 46804 | Registered Nurse | 2011-02-01 ~ 2012-01-31 |
| Shirley F Shiff | 6109 Waterside Dr, Fort Wayne, IN 46804 | Psychologist | 1994-09-19 ~ 1995-08-31 |
| Julianne Christenson | 10819 Mohave Court, Ft Wayne, IN 46804 | Registered Nurse | 2007-06-25 ~ 2008-07-31 |
| Antibus Scales & Systems Inc · Phillip D Antibus | 4809 Illinois Rd, Fort Wayne, IN 46804 | Dealer of Weighing & Measuring Devices | 2000-01-01 ~ 2000-12-31 |
| Mark Joseph Minnie | 4322 Cadillac Dr, Ft Wayne, IN 46804 | Pharmacist | 2004-02-09 ~ 2005-01-31 |
| Pro Products LLC | 7201 Engle Rd, Fort Wayne, IN 46804-2228 | Commercial Fertilizer | 2016-07-01 ~ 2017-06-30 |
| Find all Licenses in zip 46804 | |||
| City | Fort Wayne |
| Zip Code | 46804 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + Fort Wayne |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| David Keith Bowers | 263 Farmington Ave, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-06-07 ~ 2021-02-28 |
| Brian Clancy | 50 Bunting Rd, Seymour, CT 06483-3829 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jude F Clancy Md | 333 Cedar St Room 332 Fmp, New Haven, CT 06520 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jesse I Bohrer-clancy | 17549 Oak Meadow Ln, Lake Oswego, OR 97034-7616 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Keith P Cross | 925 Mix Ave Apt 1-h, Hamden, CT 06514 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
| Keith Hollinger | 55 Nye Rd Ste 101, Glastonbury, CT 06033-1281 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith L Ellis | 16 Spring St, Chester, CT 06412-1335 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith E Gipson | 986 N Farms Rd, Wallingford, CT 06492-1808 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith Rosenberg | 111 West St, Portland, ME 04102-3416 | Controlled Substance Registration for Practitioner | 2019-06-20 ~ 2021-02-28 |
| Keith E Campbell | 415 Killingworth Rd, Higganum, CT 06441 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on KEITH DAVID CLANCY.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).