JACKSON P MAILLE MD (Credential# 187851) 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.
JACKSON P MAILLE MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0026019. 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 67 Masonic Ave, Wallingford, CT 06492-3095. The current status is active.
| Licensee Name | JACKSON P MAILLE MD |
| Credential ID | 187851 |
| Credential Number | CSP.0026019 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
67 Masonic Ave Wallingford CT 06492-3095 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-28 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 553866 | 1.036274 | Physician/Surgeon | 1997-08-01 | 2019-08-01 - 2020-07-31 | ACTIVE |
| Street Address | 67 MASONIC AVE |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492-3095 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| John Huang Md | 67 Masonic Ave Ste 3100, Wallingford, CT 06492-3095 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Marcel L Green | 67 Masonic Ave Ste 2400, Wallingford, CT 06492-3095 | Chiropractor | 2020-04-01 ~ 2021-03-31 |
| David A Bowers Md | 67 Masonic Ave Ste 2100, Wallingford, CT 06492-3095 | Physician/surgeon | 2012-04-01 ~ 2013-03-31 |
| Erin E Schuster | 67 Masonic Ave Ste 2100, Wallingford, CT 06492-3095 | Physician/surgeon | 2012-04-01 ~ 2013-03-31 |
| Gregory B. Park | 67 Masonic Ave Ste 2100, Wallingford, CT 06492-3095 | Physician/surgeon | 2010-06-07 ~ 2011-04-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Andrea Zola | 53 Alison Ave., Wallingford, CT 06492 | Esthetician | ~ |
| Kyungok Choi | 90 Ward St, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Giang Nguyen | 45 Country Club Lane, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2021-11-30 |
| Lc Artistry | 207 North Colony Road, Wallingford, CT 06492 | Esthetician | ~ |
| Katie Lee | 20 Angela Dr, Wallingford, CT 06492 | Paramedic | 2020-09-01 ~ 2021-08-31 |
| Vinny's Deli | 567 Center St, Wallingford, CT 06492 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Michele Ruggiero | 26 Leigus Road, Wallingford, CT 06492 | Radiographer | 2020-07-01 ~ 2021-06-30 |
| Dianna K Ball | 104 Simpson Ave, Wallingford, CT 06492 | Speech and Language Pathologist | 2020-08-01 ~ 2021-07-31 |
| Ann Marie Richardson | 20 Mohawk Drive, Wallingford, CT 06492 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Joann Hummel | 60 Deer Run Road, Wallingford, CT 06492 | Medication Administration Certification | 2018-08-21 ~ 2020-08-20 |
| Find all Licenses in zip 06492 | |||
| City | WALLINGFORD |
| Zip Code | 06492 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + WALLINGFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Michael O'brien | 4 Jackson St, Beacon, NY 12508-3453 | Controlled Substance Registration for Practitioner | 2020-06-22 ~ 2021-02-28 |
| Jennifer S Jackson | 100 Temple St Apt 201, New Haven, CT 06510-2728 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Shantala Umashankar Md | 939 Jackson St Apt 201, San Francisco, CA 94133-4877 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Cory D Jackson | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Dowin H Boatright | 105 Jackson Rd, Hamden, CT 06517 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard E Jackson Md | 45 W Main St Po Box 738, Avon, CT 06001 | Controlled Substance Registration for Practitioner | 2008-03-01 ~ 2009-02-28 |
| Ji Hong Ahn | 34 Jackson Ave, West Hartford, CT 06110-1013 | Controlled Substance Registration for Practitioner | 2019-03-06 ~ 2021-02-28 |
| Peter D Jackson | 20 York St Tmp 209, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Elizabeth Tateoka | 27 Jackson St Apt 405, Lowell, MA 01852-2144 | Controlled Substance Registration for Practitioner | 2020-02-05 ~ 2021-02-28 |
| Kimberly K Lett | 141 Edenwood Dr, Jackson, TN 38301-3826 | Controlled Substance Registration for Practitioner | 2012-05-08 ~ 2013-02-28 |
Please comment or provide details below to improve the information on JACKSON P MAILLE MD.
| 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).