Follow the steps to complete the online Pharmacy License Form Photo

1. Click ‘Get Form’ button to access the online form and view it in your preferred editor.
2. Begin by entering the pharmacy name as it will appear on the license, ensuring it matches the DEA title.
3. Fill out the pharmacy address, including street, city, state, and zip code.
4. Provide contact details, including pharmacy phone number, fax number, and email address.
5. Input your current DEA number in the designated field.
6. Select the type of pharmacy by checking the appropriate box (e.g., retail, hospital, etc.).
7. Indicate the type of ownership by choosing one of the options provided (individual, partnership, corporation, or other) and specifying if necessary.
8. List the names, titles, and addresses of all principal owners and officers associated with the pharmacy, attaching additional sheets if needed.
9. Detail the pharmacist-in-charge's information, including name, license number, mailing address, city, state, zip, and email address.
10. For staffing details, provide names and license numbers of staff pharmacists, registered technicians, and pharmacist interns, using additional sheets as required.
11. Complete the Prescription Drug Monitoring Program (PDMP) section by indicating whether your pharmacy reports to the PDMP.
12. Attach required documents listed in the application, such as the affidavit, current licenses, inspection reports, and descriptions of pharmacy practice.
13. Review the affidavit affirming the pharmacist-in-charge understands South Dakota pharmacy laws and regulations, and ensure it is signed and dated.
14. Once all information is correctly entered, save your changes. You can then download, print, or share the completed form as needed.

Complete your Pharmacy License Form Photo online today for a smooth application process.