KELLY F WALK
Controlled Substance Registration for Practitioner


Address: 2000 Broadway Apt 6j, New York, NY 10023-5041

KELLY F WALK (Credential# 1177660) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is August 5, 2013. The license expiration date date is February 28, 2015. The license status is INACTIVE.

Business Overview

KELLY F WALK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0055808. The credential type is controlled substance registration for practitioner. The effective date is August 5, 2013. The expiration date is February 28, 2015. The business address is 2000 Broadway Apt 6j, New York, NY 10023-5041. The current status is inactive.

Basic Information

Licensee Name KELLY F WALK
Credential ID 1177660
Credential Number CSP.0055808
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 2000 Broadway Apt 6j
New York
NY 10023-5041
Business Type INDIVIDUAL
Status INACTIVE
Issue Date 2013-08-05
Effective Date 2013-08-05
Expiration Date 2015-02-28
Refresh Date 2017-05-02

Other licenses

ID Credential Code Credential Type Issue Term Status
1066916 2.010743 Dentist 2012-05-08 2013-02-01 - 2014-01-31 INACTIVE

Office Location

Street Address 2000 BROADWAY APT 6J
City NEW YORK
State NY
Zip Code 10023-5041

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City NEW YORK
Zip Code 10023
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + NEW YORK

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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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