ALEXANDRA M MCPENCOW MD (Credential# 1025331) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2013. The license expiration date date is February 28, 2015. The license status is INACTIVE.
ALEXANDRA M MCPENCOW MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0051035. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2013. The expiration date is February 28, 2015. The business address is 10100 Se Sunnyside Rd, Clackamas, OR 97015-8970. The current status is inactive.
| Licensee Name | ALEXANDRA M MCPENCOW MD |
| Credential ID | 1025331 |
| Credential Number | CSP.0051035 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
10100 Se Sunnyside Rd Clackamas OR 97015-8970 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Issue Date | 2011-07-27 |
| Effective Date | 2013-03-01 |
| Expiration Date | 2015-02-28 |
| Refresh Date | 2017-05-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 975494 | 1.049454 | Physician/Surgeon | 2011-01-24 | 2013-10-01 - 2014-09-30 | INACTIVE |
| 1085493 | CSP.0053356 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | - | INACTIVE |
| Street Address | 10100 SE SUNNYSIDE RD |
| City | CLACKAMAS |
| State | OR |
| Zip Code | 97015-8970 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jighna Shah | 15438 Se Bollam Drive, Clackamas, OR 97015 | Pharmacist | 2012-02-01 ~ 2014-01-31 |
| Susan L Mcadams | 14700 Se 132 Avenue, Clackamas, OR 97015 | Registered Nurse | 1999-07-29 ~ 2000-03-31 |
| Kent J Brooks | 15929 Se Celsiana Ct, Clackamas, OR 97015 | Nursing Home Administrator | 1995-11-03 ~ 1996-10-31 |
| Judith G Garvey · Korostinski | 13630 Se 145th Avenue, Clackamas, OR 97015 | Licensed Practical Nurse | 2002-04-25 ~ 2003-04-30 |
| Anna L Hoffman | 11950 Se Mountain Sun Dr., Clackamas, OR 97015 | Registered Nurse | 2006-02-22 ~ 2006-07-31 |
| Corson T Collet | 12470 Se Huron, Clackamas, OR 97015 | Pharmacist | 1800-12-27 ~ 1993-03-31 |
| James J Toffolo | P.o. Box 2741, Clackamas, OR 97015 | Physical Therapist | 2004-12-17 ~ 2006-01-31 |
| Virginia Beatrix Bynoe | 8899 Se Jannsen Rd, Clackamas, OR 97015-7609 | Registered Nurse - Temporary | 2010-03-10 ~ 2010-07-08 |
| Emily S Brunkhurst | 14822 Se 132nd Ave, Clackamas, OR 97015-8299 | Registered Nurse - Temporary | 2013-07-26 ~ 2013-11-22 |
| Bridgewell Resources LLC | 12420 Se Carpenter Dr, Clackamas, OR 97015-9077 | Commercial Fertilizer | 2016-07-01 ~ 2017-06-30 |
| Find all Licenses in zip 97015 | |||
| City | CLACKAMAS |
| Zip Code | 97015 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + CLACKAMAS |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Alexandra Zavin | 539 E 78th St #6i, New York, NY 10075 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Alexandra Gallina | 35 Verbena Dr, Commack, NY 11725-3716 | Controlled Substance Registration for Practitioner | 2019-08-26 ~ 2021-02-28 |
| Alexandra E Zacchera | 130 Hartford Rd, Manchester, CT 06040-5921 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Alexandra Terskiy | 20 York St Tmp 209, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Alexandra Galante | 24 Hospital Ave, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2019-05-09 ~ 2021-02-28 |
| Alexandra B Kuvaldina | 730 Randolph Rd, Middletown, CT 06457-5331 | Controlled Substance Registration for Practitioner | 2019-07-15 ~ 2021-02-28 |
| Alexandra R Vitale | 15 Riverside Ave, Bristol, CT 06010-5161 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Alexandra Kushnir Md | 247 West St, Morris, CT 06763 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Alexandra C Judah | 32 Barnabas Rd, Newtown, CT 06470-1228 | Controlled Substance Registration for Practitioner | 2017-06-16 ~ 2019-02-28 |
| Alexandra Dow Md | 700 White Plains Rd Ste 270, Scarsdale, NY 10583-5013 | 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).