Registration Application

Full Name*

VAT reg Number*

Pharmacy reg Number*

Pharmacy Address*

Pharmacy Size* <60 ㎡60 to 90 ㎡> 90 ㎡

Pharmacist Information

Full Name*

Email*

Mobile*

Pharmacist Degree*

Pharmacy Registration*

Assistant Pharmacist Information

Full Name

Email

Mobile

Accountant Information

Full Name*

Email

Mobile*

Employee Information

Full Name

Email

Mobile

Second Employee Information

Full Name

Email

Mobile

Third Employee Information

Full Name

Email

Mobile