RICHARD N FORMICA JR (Credential# 198159) 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.
RICHARD N FORMICA JR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0027005. 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 4 Split Rock Road, Bethany, CT 06524. The current status is active.
| Licensee Name | RICHARD N FORMICA JR |
| Credential ID | 198159 |
| Credential Number | CSP.0027005 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
4 Split Rock Road Bethany CT 06524 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-31 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2018-12-28 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 554439 | 1.036848 | Physician/Surgeon | 1998-05-08 | 2020-01-01 - 2020-12-31 | ACTIVE |
| Street Address | 4 Split Rock Road |
| City | Bethany |
| State | CT |
| Zip Code | 06524 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Catherine M Ford · Porto | 78 Tuttle Court, Bethany, CT 06524 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Erin Mcknight | 24 Timber Ln, Bethany, CT 06524 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Cheryl A Bevvino | 106 Sperry Rd, Bethany, CT 06524 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Catherine Geloso | 19 Amadeo Drive, Bethany, CT 06524 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Patricia Burke | 12 Miller Rd, Bethany, CT 06524 | Veterinarian | 2020-09-01 ~ 2021-08-31 |
| Complete Excavating Services LLC | 674 Amity Rd, Bethany, CT 06524 | Demolition Contractor | 2020-07-01 ~ 2021-06-30 |
| Brian K Coutermarsh | 32 Emerald Lane, Bethany, CT 06524 | Radiographer | 2020-09-01 ~ 2021-08-31 |
| Michelle L Amato | 172 Russell Rd, Bethany, CT 06524 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Joseph L Colaci | 57 Edwards Road, Bethany, CT 06524 | Nursing Home Administrator | 2020-05-01 ~ 2022-04-30 |
| Karen C Praskievicz | 85 Sperry Rd, Bethany, CT 06524 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Find all Licenses in zip 06524 | |||
| City | Bethany |
| Zip Code | 06524 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + Bethany |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nicholas B Formica | 22 Pine St, Bristol, CT 06010-6948 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Joseph J Formica | 8690 Marlamoor Ln, West Palm Beach, FL 33412 | Controlled Substance Registration for Practitioner | 2007-03-19 ~ 2008-02-29 |
| Richard S Lee | 196 Crown St Apt 402, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | 2004-10-25 ~ 2005-02-28 |
| Richard M Goldman | Po Box 518, Fairfield, CT 06824-0518 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard A Segool | 115 Elm St, Enfield, CT 06082 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard Young Pa | Belmont, VT 05730 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Richard S Gottfried M.d. | 1 Theall Rd, Rye, NY 10580 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Richard C Hsu Md | 7 Germantown Rd, Danbury, CT 06810 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Richard N Smith | Po Box 388, Middlebury, CT 06762 | Controlled Substance Registration for Practitioner | 2016-06-16 ~ 2019-02-28 |
| Richard L Yap Md | 151 Andrew Ave Apt 85, Naugatuck, CT 06770 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
Please comment or provide details below to improve the information on RICHARD N FORMICA JR.
| 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).