RUSSELL E RANDALL JR
Controlled Substance Registration for Practitioner


Address: 29832 Dutchmans Ln, Easton, MD 21601-4712

RUSSELL E RANDALL JR (Credential# 214417) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is May 21, 2009. The license expiration date date is February 28, 2011. The license status is INACTIVE.

Business Overview

RUSSELL E RANDALL JR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0028413. The credential type is controlled substance registration for practitioner. The effective date is May 21, 2009. The expiration date is February 28, 2011. The business address is 29832 Dutchmans Ln, Easton, MD 21601-4712. The current status is inactive.

Basic Information

Licensee Name RUSSELL E RANDALL JR
Credential ID 214417
Credential Number CSP.0028413
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 29832 Dutchmans Ln
Easton
MD 21601-4712
Business Type INDIVIDUAL
Status INACTIVE
Effective Date 2009-05-21
Expiration Date 2011-02-28
Refresh Date 2013-03-07

Other licenses

ID Credential Code Credential Type Issue Term Status
544698 1.023700 Physician/Surgeon 1982-06-24 2008-09-22 - 2009-10-31 INACTIVE

Office Location

Street Address 29832 DUTCHMANS LN
City EASTON
State MD
Zip Code 21601-4712

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Patricia A West 214-b Talbot Street, Easton, MD 21601 Registered Nurse 2006-01-23 ~ 2006-09-30
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Competitor

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City EASTON
Zip Code 21601
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + EASTON

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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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