Last updated: 12/18/2024
Pharmacy License Application {DOH 690-152}
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Description
DOH 690-152 - PHARMACY LICENSE APPLICATION. The form is used to apply for or modify a pharmacy license. It is required for a new pharmacy, changes in ownership, changes in location, or name changes of an existing pharmacy. It collects demographic and facility information, including the legal owner/operator’s details, the facility's type and hours, and DEA registration information. The form also asks for disclosures about any professional license suspensions or criminal violations related to drugs or controlled substances, along with information about the pharmacist in charge. Applicants must certify the accuracy of the information provided and agree to comply with state regulations. www.FormsWorkflow.com
