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Get NC DHHS 225

Ephone: _____________________ Name of Applicant (Facility Name) Application for Registration Mailing Address under N.C. Controlled Substances Act of 1971 _________________________________________________________ Location _________________________________________________________ DHHS Registration No. ___________________ Town DEA No. ___________________ County Applicant Telephone: State Zip ___________________________________________ Area Code RETAIN COPY Mail Application to: Depar.

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