EUGENE FANTL (Credential# 150383) 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.
EUGENE FANTL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0008905. 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 170 Flanders Road, East Lyme, CT 06333. The current status is active.
| Licensee Name | EUGENE FANTL |
| Credential ID | 150383 |
| Credential Number | CSP.0008905 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
170 Flanders Road East Lyme CT 06333 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 543155 | 1.019762 | Physician/Surgeon | 1978-07-25 | 2019-04-01 - 2020-03-31 | ACTIVE |
| 497219 | CSP.0043228 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2008-03-12 | 2014-01-27 - 2015-02-28 | INACTIVE |
| 1269325 | 1 | Physician/Surgeon | - | PENDING |
| Street Address | 170 FLANDERS ROAD |
| City | EAST LYME |
| State | CT |
| Zip Code | 06333 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Debra L Siegel | 170 Flanders Road, East Lyme, CT 06357 | Real Estate Salesperson | 2011-06-01 ~ 2012-05-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brittany Pearson | 6201 Maple Tree Lane, East Lyme, CT 06333 | Behavior Analyst | ~ |
| Aura M Serdici | 7 Ferro Dr, East Lyme, CT 06333 | Esthetician | ~ |
| Lawrence J Darling Jr · Darling Carpentry | 61 Mostowy Rd, East Lyme, CT 06333 | Home Improvement Contractor | 2020-06-19 ~ 2020-11-30 |
| Sandeep B Varma | 30 Plum Hill Road, East Lyme, CT 06333 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Peter J Famiglietti Md | 339 Flanders Road, East Lyme, CT 06333 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Beth A Stoddard | 8 Greentree Drive, East Lyme, CT 06333 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Scott's Yankee Farmer | 291 N Bride Brook Rd, East Lyme, CT 06333 | Apple Juice & Cider Manufacturer | 2020-07-01 ~ 2021-06-30 |
| Katherine E Whalen | 339 Flanders Rd Ste 109, East Lyme, CT 06333 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| May L Diep | 88 Arbor Crossing, East Lyme, CT 06333 | Nail Technician | ~ |
| Cash True Value | 300 Flanders Rd, East Lyme, CT 06333 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06333 | |||
| City | EAST LYME |
| Zip Code | 06333 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + EAST LYME |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eugene A Winchester | Eugene Winchester, Md, Mystic, CT 06355 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Eugene Cho | 40-32 215th St, Bayside, NY 11361-2132 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Eugene Pak | 123 York St #6l, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2005-03-01 ~ 2006-02-28 |
| Eugene Krc Md | 11 Legrand Rd, North Haven, CT 06473-1013 | Controlled Substance Registration for Practitioner | 1997-03-01 ~ 1998-02-28 |
| Eugene M Lipira Md | 196 Redding Rd, Georgetown, CT 06829 | Controlled Substance Registration for Practitioner | 1993-05-26 ~ 1995-03-01 |
| Eugene G Sheffield | 2535 Rue De Vl, Irving, TX 75038-5676 | Controlled Substance Registration for Practitioner | 2015-07-14 ~ 2017-02-28 |
| Eugene H Corley Md | 114 Coachlight Sq, Bridgeport, CT 06606 | Controlled Substance Registration for Practitioner | 2002-03-01 ~ 2003-02-28 |
| Eugene R Bertolli | 73 Reynolds Dr, Meriden, CT 06450-2532 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Eugene D Shapiro Md | 47 Bellevue Rd, New Haven, CT 06511 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Eugene K Hall | 333 Cedar St, New Haven, CT 06510-3206 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on EUGENE FANTL.
| 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).