Elsa Russom Controlled Substance Registration for Practitioner
3 Marvin Street, Norwalk, CT 06855


Elsa Russom is licensed in the eLicensing system of Connecticut. The license credential ID is 1186765. The license type is CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER. The license status is ACTIVE. The address is 3 Marvin Street, Norwalk, CT 06855. The zip code is 06855.


Elsa Russom · 3 Marvin Street, Norwalk, CT 06855

Credential ID 1186765
Name ELSA RUSSOM
Type INDIVIDUAL
Address 3 Marvin Street
Norwalk, CT 06855
License Credential CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Full Credential Code CSP.0056192
Credential Type CSP
Credential Number 56192
Status ACTIVE
Status Reason CURRENT
Active 1
Issue Date 09/26/2013
Effective Date 03/01/2015
Expiration Date 02/28/2017
Record Refresh Date 01/21/2015

street_number: 3
route: Marvin Street (Marvin St)
locality, political: Norwalk
admin_level_2, political: Fairfield County
admin_level_1, political: Connecticut (CT)
country, political: United States (US)
postal_code: 06855
postal_code_suffix: 2002
types : premise
latitude: 41.0956881
longitude: -73.3978034
latlng: (41.0956881, -73.3978034)


Zip 06855 · Controlled Substance Registration for Practitioner · Connecticut Business

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