MINA LOUIS HABIB BOUTROUS (Credential# 1807193) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is November 19, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
MINA LOUIS HABIB BOUTROUS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0072805. The credential type is controlled substance registration for practitioner. The effective date is November 19, 2019. The expiration date is February 28, 2021. The business address is 8814 Oak Creek Dr, Saint Louis, MO 63126-2130. The current status is active.
| Licensee Name | MINA LOUIS HABIB BOUTROUS |
| Credential ID | 1807193 |
| Credential Number | CSP.0072805 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
8814 Oak Creek Dr Saint Louis MO 63126-2130 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-11-19 |
| Effective Date | 2019-11-19 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-11-21 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1692548 | 1.064496 | Physician/Surgeon | 2019-10-28 | 2019-10-28 - 2020-09-30 | ACTIVE |
| Street Address | 8814 OAK CREEK DR |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63126-2130 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Michael Patrick Cuddihee | 8806 Fox Park Drive, St. Louis, MO 63126 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Laura Pastrana | 969 Westglen Drive, Saint Louis, MO 63126 | Registered Nurse | 2018-01-05 ~ 2018-06-30 |
| Ralph E Wolfram | 1405 Starling Dr, Crestwood, MO 63126 | Professional Engineer | 1996-02-01 ~ 1997-01-31 |
| Christine M Scott | 927 Grovena, Crestwood, MO 63126 | Speech and Language Pathologist | ~ 1996-02-29 |
| Judith A Giacoletto | 11258 Gravois, St Louis, MO 63126 | Registered Nurse | 1993-11-10 ~ 1994-12-31 |
| Charleen M Schindler | 830 Hawkins Ct, St Louis, MO 63126 | Registered Nurse | 2007-05-23 ~ 2008-04-30 |
| Nicole R Van Vickle | 1053 Westglen Drive, St. Louis, MO 63126 | Registered Nurse | 2006-09-07 ~ 2007-05-31 |
| Michael C Curran | 8841 Fox Park Dr, St Louis, MO 63126 | Temporary Certified General Real Estate Appraiser | 2001-02-27 ~ 2001-09-26 |
| Coast Guard Auxiliary Association Inc. | 9449 Watson Industrial Park, St. Louis, MO 63126-1522 | Public Charity-exempt From Financial Requirements | ~ |
| Joseph A Carter | 8850 Glen Rose Dr, Saint Louis, MO 63126-2314 | Professional Engineer | 2018-02-01 ~ 2019-01-31 |
| Find all Licenses in zip 63126 | |||
| City | SAINT LOUIS |
| Zip Code | 63126 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + SAINT LOUIS |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Habib Khan | 123 York St, New Haven, CT 06511-5655 | Controlled Substance Registration for Practitioner | 2009-10-07 ~ 2011-02-28 |
| Larissa Ann Habib | 40 Temple St, New Haven, CT 06510-2718 | Controlled Substance Registration for Practitioner | 2019-07-22 ~ 2021-02-28 |
| Habib Hamoud | 137-03 168 Street, Jamaica, NY 11434 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Nader N Habib Md | 413 Canoe Brook, Shelton, CT 06484 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Ishtiaq A Habib | 7 Old Sherman Tpke Ste 200, Danbury, CT 06810-4174 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Sarah Habib | 34 Lakeshore Dr Unit 27b, Farmington, CT 06032-4215 | Controlled Substance Registration for Practitioner | 2013-03-05 ~ 2015-02-28 |
| Habib Mujib Khan | 129 York St Apt 7j, New Haven, CT 06511-5606 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Mina Masry | 365 Montauk Ave, New London, CT 06320-4700 | Controlled Substance Registration for Practitioner | 2020-02-25 ~ 2021-02-28 |
| Mina Chang | 64 Robbins St, Waterbury, CT 06708-2613 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Mina Owlia | 112 Southfield Ave Apt 402, Stamford, CT 06902-7637 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
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| 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).