Pharmacy Registration

Note:

Your IP Address and location details are captured as part of this submission. Your IP Location: 18.217.26.8
You agree for us to hold this information as part of this submission. We require this for security and legal purposes.

Pharmacy Information

Pharmacy Name

Pharmacy Address

Address Line 1

City

Post Code

Country

Pharmacist(s) Information

Pharmacist Name

GPhC No.

4 Digit Pin

Passport / Photo ID Scanned

Choose File

Proof of your address

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Any other Comments or Questions

I confirm that all provided details are accurate to the best of my knowledge. I take full responsibility for any misrepresented information and acknowledge that providing false information may lead to legal consequences, including potential liability for fraud or identity theft.

I consent to have eHealth Solutions Ltd. my submitted information so they can process my registration and, if needed I can request to delete my data on my request under the GDPR guidelines.

I have read and agree to the Terms and Conditions and Privacy Policy