GRACE KOOPER MD (Credential# 448822) 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.
GRACE KOOPER MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0040466. 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 28 Willis Dr, Cumberland, RI 02864-2066. The current status is active.
| Licensee Name | GRACE KOOPER MD |
| Credential ID | 448822 |
| Credential Number | CSP.0040466 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
28 Willis Dr Cumberland RI 02864-2066 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2006-10-18 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 562394 | 1.044812 | Physician/Surgeon | 2006-10-02 | 2019-10-01 - 2020-09-30 | ACTIVE |
| Street Address | 28 WILLIS DR |
| City | CUMBERLAND |
| State | RI |
| Zip Code | 02864-2066 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Stephen Anthony Costa | 61 North Garden Street, Cumberland, RI 02864 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Nelson M Caetano | 14 Royal Court, Cumberland, RI 02864 | Pharmacist | 2020-06-01 ~ 2022-01-31 |
| M Weisman Roofing Company Inc | 20 Industrial Road, Cumberland, RI 02864 | Major Contractor | 2020-07-01 ~ 2021-06-30 |
| Saman Mirzaei | 7 Angus Dr, Cumberland, RI 02864 | Temporary Permit To Practice Pharmacy | 2019-11-05 ~ 2020-04-30 |
| Vickie Jean Lamontagne | 10 Roberts St, Cumberland, RI 02864 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Paul E Fisher | 4 Woodcrest Dr., Cumberland, RI 02864 | Certified Residential Real Estate Appraiser | 2020-05-01 ~ 2021-04-30 |
| Jennifer K Keating | 10 White Hill Lane, Cumberland, RI 02864 | Registered Nurse | 2020-01-01 ~ 2020-12-31 |
| Derek Douglas Banner | 2175 Mendon Road, Cumberland, RI 02864 | Casino Class I Employee | 2020-01-28 ~ 2020-10-31 |
| Henry John La Rose | 99 Roland Street, Cumberland, RI 02864 | Casino Class I Employee | 2019-12-11 ~ 2020-10-31 |
| Gregory Barbeau | 51 Front Street Apt 240, Cumberland, RI 02864 | Casino Class I Employee | 2019-12-11 ~ 2020-10-31 |
| Find all Licenses in zip 02864 | |||
| City | CUMBERLAND |
| Zip Code | 02864 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + CUMBERLAND |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Grace J. Kim | 625 Whitney Ave Apt 6, New Haven, CT 06511-2281 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Grace Lee | 330 Cedar St, New Haven, CT 06510-3218 | Controlled Substance Registration for Practitioner | 2020-03-09 ~ 2021-02-28 |
| Grace Y Cha | 38 Ward St Apt 4, Middletown, CT 06457-4139 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Grace M Lee | 100 Temple St #201, New Haven, CT 06510-2331 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Rozlyn Grace Poray | 301 Central Rd, Rye, NH 03870 | Controlled Substance Registration for Practitioner | 2018-12-06 ~ 2021-02-28 |
| Grace Chin Dds | 8 Bradshaw Ct, Hillsdale, NJ 07642-2453 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Irene Grace Kho | 123 York St Apt 22l, New Haven, CT 06511-5630 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Grace Totoe | 56 Franklin St, Waterbury, CT 06706 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Grace A Dixon | 20 York St, New Haven, CT 06510-3220 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Grace K Moy Md | 11 1/2 Greenwich Park Apt 3, Boston, MA 02118-3003 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
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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).