PHILIP SAMUEL BLACK (Credential# 1615342) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
PHILIP SAMUEL BLACK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004359. The credential type is physician assistant. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 1020 Oak St, Coatesville, PA 19320-3830. The current status is active.
| Licensee Name | PHILIP SAMUEL BLACK |
| Credential ID | 1615342 |
| Credential Number | 23.004359 |
| Credential Type | Physician Assistant |
| Business Address |
1020 Oak St Coatesville PA 19320-3830 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-12-18 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-02-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1621345 | CSP.0070008 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-12-19 | 2018-12-19 - 2021-02-28 | ACTIVE |
| Street Address | 1020 OAK ST |
| City | COATESVILLE |
| State | PA |
| Zip Code | 19320-3830 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Allison E Radwick | 52 Sarahs Way, East Fallowfield, PA 19320 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Karen S Boyer | 411 Dogwood Lane, Coatesville, PA 19320 | Registered Nurse | 2019-10-01 ~ 2020-09-30 |
| Michael J Coffey | 287 Hurley Rd, Coatesville, PA 19320 | Elevator Unlimited Journeyperson | 2019-09-01 ~ 2020-08-31 |
| Angela Lynn Kelly | 212 Elmwood Lane, Coatesville, PA 19320 | Registered Nurse | 2019-10-01 ~ 2020-09-30 |
| John Horgan Inc | 918 Colonial Crt, Coatesville, PA 19320 | Home Improvement Contractor | 2007-11-20 ~ 2008-11-30 |
| Friends of Peb Inc | 1151 Fox Run Dr, Coatesville, PA 19320 | Public Charity-exempt From Financial Requirements | 2017-09-08 ~ |
| Charles John Hennessy | 3460 Doe Run Church Rd, Coatesville, PA 19320 | Registered Nurse | 2016-10-07 ~ 2017-04-30 |
| Joseph A Rooney | 1503 Olive St, Coatesville, PA 19320 | Professional Engineer | 1998-03-17 ~ 1999-01-31 |
| George E Rodgers | 202-4 W Bonsall Schl Rd, Coatesville, PA 19320 | Professional Engineer | 1994-01-03 ~ 1995-01-31 |
| James D Mcguigan | 1218 Caln Meeting Rd, Coatesville, PA 19320 | Professional Engineer | 1999-02-01 ~ 2000-01-31 |
| Find all Licenses in zip 19320 | |||
| City | COATESVILLE |
| Zip Code | 19320 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + COATESVILLE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Samuel Adams Black Ipa | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2019-07-11 ~ 2022-05-21 |
| Samuel Adams Black Lager | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2018-06-25 ~ 2021-06-24 |
| Samuel Adams Double Black | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2019-01-22 ~ 2022-01-20 |
| Samuel Adams Rebel Black Ipa | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2019-06-21 ~ 2022-06-19 |
| Samuel Shajnfeld | 66-10 Booth St, Rego Park, NY 11374-4634 | Physician Assistant | 2012-11-01 ~ 2013-10-31 |
| Samuel C Silva | 2 Wimisink Road, Sherman, CT 06784 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Philip J Bergen | 4 Sky Edge Ln, Bethel, CT 06801-1023 | Physician Assistant | 2020-06-03 ~ 2021-03-31 |
| Lawrence Flynn Pa | 23 Philip Dr, Storrs, CT 06268 | Physician Assistant | 2007-01-23 ~ 2008-03-31 |
| Philip M. Roach Pa | 3 David Dr, Simsbury, CT 06070-3043 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Brandon Philip Lombardo | 301 Vilna Rd, Pittston, PA 18640 | Physician Assistant | 2017-10-04 ~ 2018-05-31 |
Please comment or provide details below to improve the information on PHILIP SAMUEL BLACK.
| 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).