License holder summary

SAMUEL RICHARD PESIN is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for SAMUEL RICHARD PESIN is 7305 WEST JEFFERSON BOULEVARD, FORT WAYNE IN 46804. This licensed professional license is not current. The license was granted 10/07/1993 and expired on 06/30/2001.

Indiana

Professional Licensing Agency

SAMUEL RICHARD PESIN
Controlled Substance Registration - Physician
License number
01041705B
Date granted
10/07/1993
Date expires
06/30/2001
Class
Controlled Substance Registration - Physician
Status
Expired
Address
7305 WEST JEFFERSON BOULEVARD, FORT WAYNE IN 46804
indianalicensing.org
ID 5854454
LAST UPDATED 2024-05-02 10:03:23 UTC

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