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Pharmacy Registration
Join the Network of Pharmacies
Pharmacy Application Form
Head Pharmacist Info
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Head Pharmacist's Full Names
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Head Pharmacist's Full Names
First Name
First Name
Last Name
Last Name
Gender
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Male
Female
Date of Birth
Pharmacist's Email
Pharmacist's Phone
Qualifications
Bachelor of Science in Pharmacy (BSc.Pharm)
Master of Science in Pharmacy (MSc.Pharm)
Doctor of Philosophy in Pharmacy (PhD)
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Pharmacy Info
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Name of Pharmacy / Institution
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Physical Address
Pharmacy Email
Pharmacy Phone
Operating Hours
Business Reg Certificate
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Maximum file size: 5MB
ZAMRA Reg Certificate
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Maximum file size: 5MB
Upload Pharmacy Logo Image
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Maximum file size: 3MB
Portal Account Details
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Suggested User Name
Notifications Email
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Notifications Phone
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Password
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