JAN P FUGAL
Controlled Substance Registration for Practitioner


Address: 1556 New Haven Ave, Woodmont, CT 06460

JAN P FUGAL (Credential# 158190) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2009. The license expiration date date is February 28, 2011. The license status is INACTIVE.

Business Overview

JAN P FUGAL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0016917. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2009. The expiration date is February 28, 2011. The business address is 1556 New Haven Ave, Woodmont, CT 06460. The current status is inactive.

Basic Information

Licensee Name JAN P FUGAL
Credential ID 158190
Credential Number CSP.0016917
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 1556 New Haven Ave
Woodmont
CT 06460
Business Type INDIVIDUAL
Status INACTIVE
Effective Date 2009-03-01
Expiration Date 2011-02-28
Refresh Date 2011-01-20

Other licenses

ID Credential Code Credential Type Issue Term Status
540765 1.013520 Physician/Surgeon 1985-08-30 2009-08-01 - 2010-06-27 INACTIVE

Office Location

Street Address 1556 NEW HAVEN AVE
City WOODMONT
State CT
Zip Code 06460

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Competitor

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City WOODMONT
Zip Code 06460
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + WOODMONT

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Dataset Information

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).

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