UMASS MEMORIAL MEDICAL CENTER SPECIALTY PHARMACY (Credential# 1126949) is licensed (Nonresident Pharmacy) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2019. The license expiration date date is August 31, 2020. The license status is ACTIVE.
UMASS MEMORIAL MEDICAL CENTER SPECIALTY PHARMACY is licensed with the Department of Consumer Protection of Connecticut. The credential number is #PCN.0002404. The credential type is nonresident pharmacy. The effective date is September 1, 2019. The expiration date is August 31, 2020. The business address is 55 Lake Ave North Acc Building 1st Floor, Worcester, MA 01655-0002. The current status is active.
| Licensee Name | UMASS MEMORIAL MEDICAL CENTER SPECIALTY PHARMACY |
| Business Name | UMASS MEMORIAL MEDICAL CENTER SPECIALTY PHARMACY |
| Credential ID | 1126949 |
| Credential Number | PCN.0002404 |
| Credential Type | NONRESIDENT PHARMACY |
| Business Address |
55 Lake Ave North Acc Building 1st Floor Worcester MA 01655-0002 |
| Business Type | CORPORATION |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2013-03-20 |
| Effective Date | 2019-09-01 |
| Expiration Date | 2020-08-31 |
| Refresh Date | 2019-07-25 |
| Street Address | 55 LAKE AVE NORTH ACC BUILDING 1ST FLOOR |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655-0002 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nils Henninger | 55 Lake Ave N, Worcester, MA 01655-0002 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Susanne Muehlschlegel Md | 55 Lake Ave N, Worcester, MA 01655-0002 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Adalia H. Jun-o'connell | 55 Lake Ave N, Worcester, MA 01655-0002 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Leslie J Domalik | 55 Lake Ave N, Worcester, MA 01655-0002 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Raphael A Carandang Md | 55 Lake Ave N, Worcester, MA 01655-0002 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Daniel J Weber | 55 Lake Ave N, Worcester, MA 01655-0002 | Physician/surgeon | 2017-10-01 ~ 2018-09-30 |
| Philippe B Rosenberg | 55 Lake Ave N, Worcester, MA 01655-0002 | Physician/surgeon | ~ |
| Wiley R Hau Md | 55 Lake Ave N, Worcester, MA 01655-0002 | Controlled Substance Registration for Practitioner | ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carolina Ionete | 55 Lake Avenue, Worcester, MA 01655 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Thomas J Fitzgerald | 55 Lake Ave, N, Worcester, MA 01655 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Majaz Moonis Md | Umassmemorial Health Care, Neurology, 55 Lake Ave, Worcester, MA 01655 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Ari Wilkenfeld | Neurology Department � 5th Floor, Worcester, MA 01655 | Physician/surgeon | ~ |
| Kate Daniello | 55 N Lake Ave, Worcester, MA 01655 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Brian Silver | 55 Lake Avenue North, Worcester, MA 01655 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Andrew Bouley | Umass Memorial, Department of Neurology, Worcester, MA 01655 | Physician/surgeon | 2019-04-01 ~ 2020-03-31 |
| Cheryl A Laflamme Aprn | 58 Bentwood Dr, Sturbridge, MA 01655 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Lawrence S Rosenthal Md | Umass Memorial Medical Center, Worcester, MA 01655 | Physician/surgeon | 2016-08-01 ~ 2017-07-31 |
| Daniel Z Fisher Md | 55 Lake Ave North, Worcester, MA 01655 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Find all Licenses in zip 01655 | |||
| City | WORCESTER |
| Zip Code | 01655 |
| License Type | NONRESIDENT PHARMACY |
| License Type + County | NONRESIDENT PHARMACY + WORCESTER |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Caremark Florida Specialty Pharmacy LLC · Cvs/specialty | 7930 Woodland Center Blvd Ste 500, Tampa, FL 33614-2435 | Nonresident Pharmacy | 2019-09-01 ~ 2020-08-31 |
| Specialty Pharmacy Inc · Specialty Pharmacy, Inc. | 309b Henderson Drive, Sharon Hill, PA 19079 | Nonresident Pharmacy | 2002-09-01 ~ 2003-08-31 |
| Gregory A Taggart Md · Center for Orthopaedics | Umass Memorial Medical Center, Worcester, MA 01605 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
| Benevere Specialty Pharmacy | 60 Market Center Dr Ste 103, Collierville, TN 38017-7077 | Nonresident Pharmacy | 2019-09-01 ~ 2020-08-31 |
| Highland Specialty Pharmacy LLC | 23 Town Center Sq, Hattiesburg, MS 39402-7040 | Nonresident Pharmacy | 2019-09-01 ~ 2020-08-31 |
| Abraham Like | Umass Memorial Medical Center, Worcester, MA 01655 | Physician/surgeon | 2005-06-16 ~ 2006-07-31 |
| Ingeniorx Specialty · Cvs Specialty | 1451 Center Crossing Rd, Las Vegas, NV 89144-7047 | Nonresident Pharmacy | ~ |
| Lawrence S Rosenthal Md | Umass Memorial Medical Center, Worcester, MA 01655 | Physician/surgeon | 2016-08-01 ~ 2017-07-31 |
| Joel M Gore Md | Umass Memorial Medical Center, Worcester, MA 01655 | Physician/surgeon | 2012-04-01 ~ 2013-03-31 |
| Kurt G Barringhaus | Umass Memorial Medical Center, Worcester, MA 01655 | Physician/surgeon | 2013-09-01 ~ 2014-08-31 |
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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).