J NATHAN HAGSTROM (Credential# 196973) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2017. The license expiration date date is February 28, 2019. The license status is LAPSED.
J NATHAN HAGSTROM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0027166. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2017. The expiration date is February 28, 2019. The business address is 5955 Lori Court, Center Valley, PA 18034. The current status is lapsed.
| Licensee Name | J NATHAN HAGSTROM |
| Credential ID | 196973 |
| Credential Number | CSP.0027166 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
5955 Lori Court Center Valley PA 18034 |
| Business Type | INDIVIDUAL |
| Status | LAPSED |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2017-03-01 |
| Expiration Date | 2019-02-28 |
| Refresh Date | 2019-03-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 554500 | 1.036909 | Physician/Surgeon | 1998-05-29 | 2017-09-01 - 2018-08-31 | INACTIVE |
| Street Address | 5955 Lori Court |
| City | Center Valley |
| State | PA |
| Zip Code | 18034 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Olympus America, Inc. | 3500 Corporate Parkway, Center Valley, PA 18034 | Out of State Manufacturer of Drugs, Cosmetics & Medical Devices | 2019-12-04 ~ |
| Jennifer Dumas | 4815 Leeds Court, Center Valley, PA 18034 | Registered Nurse | 2015-06-01 ~ 2016-06-30 |
| Sharon Baca | 4512 Keene St., Center Valley, PA 18034 | Registered Nurse | 2008-07-11 ~ 2009-07-31 |
| Maribeth Todisco | 6480 Fawn Ln, Center Valley, PA 18034 | Registered Nurse | 2000-11-21 ~ 2001-12-31 |
| Elin L Oudheusden | 3475 Laurel Lane, Center Valley, PA 18034 | Registered Nurse | 1993-12-16 ~ 1994-09-30 |
| Kathleen E Kane Md | 5302 Pineview Dr, Center Valley, PA 18034 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Frank M Wang | 3406 Courtney Dr, Center Valley, PA 18034-8106 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Sheila M Hagstrom | 5955 Lori Ct, Center Valley, PA 18034-8222 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Denise Ann Kehley-stahl | 3070 Harvest Ct, Center Valley, PA 18034-9241 | Registered Nurse | ~ |
| City | Center Valley |
| Zip Code | 18034 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + Center Valley |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nathan W Liu | 330 Nob Hill Dr, Elmsford, NY 10523-2435 | Controlled Substance Registration for Practitioner | 2014-07-31 ~ 2015-02-28 |
| Nathan P Lemay | 14 Equestrian Way, Scarborough, ME 04074-9631 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Meena Nathan Md | 400 Brookline Ave, Apt 4c, Boston, MA 02215 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Nathan H Brewer | 10 Grace Ln, Killingworth, CT 06419-1312 | Controlled Substance Registration for Practitioner | 2011-07-21 ~ 2013-02-28 |
| Nathan L Grimm | 8 Intuition Cir, Durham, NC 27705-2881 | Controlled Substance Registration for Practitioner | 2019-04-18 ~ 2021-02-28 |
| Nathan B Pliam Md | 47 Carter Rd, Kent, CT 06757 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Nathan Clendenen | 46 Andrews Ave, Milford, CT 06460 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Nathan C Swallow | 100 Retreat Ave Ste 403, Hartford, CT 06106-2528 | Controlled Substance Registration for Practitioner | 2019-03-28 ~ 2021-02-28 |
| Nathan Selsky | 36 Neptune Ave, Norwalk, CT 06854 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Nathan F Coonrod | 96 Danbury Rd, Ridgefield, CT 06877 | Controlled Substance Registration for Practitioner | 2001-03-01 ~ 2002-02-28 |
Please comment or provide details below to improve the information on J NATHAN HAGSTROM.
| 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).