Pharmacist License

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    Verification

    SSN

    Demographics

    * Last Name * First Name Middle Name Maiden Name
    * Address 1 Lot/Apt #
    * City * State * Zip * County
    * Phone # * Date of Birth Cell Phone # * Email
    * Sex * Are you a United States Citizen? CPE Monitor #

    Education Details

    INFORMATION ABOUT PHARMACY EDUCATION

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    INFORMATION ABOUT PRE-PHARMACY EDUCATION

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    Regulatory Questions

    1. Have you been arrested of a felony or misdemeanor, excluding minor traffic violations?

    Documents

    Photo Click Here To Upload Photo
    (Please upload a 2x2 Passport size photograph that is less than 6 months old)
    NABP Reciprocity Application
    Please upload the entire NABP application as one document. Do not upload one page at a time.

    FPGEC Certificate

    Driver's License

    Birth Certificate

    Legal Presence

    College Affidavit

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    Affirm pay and submit

    I understand that I must comply with the provisions of the Alabama Practice Act, Rules of the Board and all other applicable statues and rules.
    I affirm that all information provided herein is true and correct and I recognize that providing false information may result in disciplinary action

    Date : 08/16/2017 * Controlled Substance

    (Board of Pharmacy charge will appear as "ALA ST BOARD OF PHARM" and convenience fee will appear as "iGov ePay LLC" on your statement.)

    *Examination Fee : *Permit Fee : *Controlled Substance Fee :
    *Transaction Fee : *Total :
    * Person's Name on Card: *Select Debit or Credit : *Card Type :
    *Card # : *Expiration Date :
    * Security Code :
    (Board of Pharmacy charge will appear as "ALA ST BOARD OF PHARM" and convenience fee will appear as "iGov ePay LLC" on your statement.)
     

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