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Pb.ca Community Pharmacy Self-Assessment GENERAL INFORMATION Pharmacy Name: Pharmacist-in-Charge: Pharmacy Licence #: Pharmacy Address and Other Relevant Information: Street Address P.O. Box (if applicable) City/Town Postal Code ( ) ( ) Phone Number Fax Number Pharmacy Email Address Pharmacy Website Pharmacy Practice Management System (Software Vendor) Please indicate the expected hours of operation for the pharmacy: Pharmacy Hours: Dispensary Hours (if different): MON-FRI MON-FR.

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