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License Transfer for Pharmacists

Applicant Information

Place of Birth


City	County If not born in North Dakota, please select Out of State.	State If not born in the US, please select Out of Country.	Country

Contact Information

Military Question


Are you a spouse of an active member of the military?	Yes	No

School Information


Name of School/College of Pharmacy Graduated from

Certificates


Please indicate your Name and City as you want it to appear on your Original Certificate.
Name	City	State

Any changes in the above information must be reported to the Board of Pharmacy Office immediately.

North Dakota Board of Pharmacy