PHILIP W MACK MD (Credential# 1006138) 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.
PHILIP W MACK MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0050666. 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 6 Ericka Cir, East Longmeadow, MA 01028-1658. The current status is active.
| Licensee Name | PHILIP W MACK MD |
| Credential ID | 1006138 |
| Credential Number | CSP.0050666 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
6 Ericka Cir East Longmeadow MA 01028-1658 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2011-07-13 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-22 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 999570 | 1.050085 | Physician/Surgeon | 2011-07-05 | 2020-01-01 - 2020-12-31 | ACTIVE |
| Street Address | 6 ERICKA CIR |
| City | EAST LONGMEADOW |
| State | MA |
| Zip Code | 01028-1658 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kathleen Stezko | 29 Autumn Ridge, East Longmeadow, MA 01028 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Sergy Chebotarev | 38 Lenox Circle, East Longmeadow, MA 01028 | Tax Preparer/facilitator Permit | 2020-06-18 ~ 2022-06-30 |
| Breanna Lynn Cloonan | 11 Acorn Street, East Longmeadow, MA 01028 | Physical Therapist Assistant | 2020-07-01 ~ 2021-06-30 |
| Maureen Teresa Blanchard | 70 Somers Rd, East Longmeadow, MA 01028 | Esthetician | ~ |
| Erica J Mcnamara | 30 Villanova Street, East Longmeadow, MA 01028 | Real Estate Salesperson | 2020-06-15 ~ 2021-05-31 |
| Jerry E Gray | C/o Abide Inc., East Longmeadow, MA 01028 | Lead Abatement Supervisor | 2020-09-01 ~ 2021-08-31 |
| Devin T Mccorison | C/o Abide, Inc., East Longmeadow, MA 01028 | Asbestos Abatement Supervisor | 2020-09-01 ~ 2021-08-31 |
| Susan B Chunyk | Hampden Hearing Ctr, East Longmeadow, MA 01028 | Audiologist | 2020-08-01 ~ 2021-07-31 |
| Mario Tascon | 202 Canterbury Circle, East Longmeadow, MA 01028 | Real Estate Salesperson | 2020-06-08 ~ 2021-05-31 |
| Jeong Ja Lee | 25 Robin St, East Longmeadow, MA 01028 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Find all Licenses in zip 01028 | |||
| City | EAST LONGMEADOW |
| Zip Code | 01028 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + EAST LONGMEADOW |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Alphonso L Mack | 30, Burlington, CT 06103 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Michael J Mack | 40 E Putnam Avenue, Cos Cob, CT 06807 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| John E Kelleher Jr | 26 Mack Rd, Middlefield, CT 06455-1104 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Lisa Mack | 85 Seymour St, Hartford, CT 06106-5501 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| James G Pattillo IIi | 74 Mack St, Windsor, CT 06095 | Controlled Substance Registration for Practitioner | 1999-03-01 ~ 2000-02-28 |
| Steven C Fitch | 321 Mack Rd, Lebanon, CT 06249-1718 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Sarah Daigle | 72 Mack St., Windsor, CT 06095 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jeremy Roger Mack | 19 E 88th St Apt 1d, New York, NY 10128-0558 | Controlled Substance Registration for Practitioner | 2019-07-16 ~ 2021-02-28 |
| Christina N Mack | 850 Grand Ave Unit 204, New Haven, CT 06511-4974 | Controlled Substance Registration for Practitioner | 2013-03-06 ~ 2015-02-28 |
| Jane A Mack | 1918 Huntington Tpk, Trumbull, CT 06611 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
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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).