Facility Information

Working Days/Hours

Does the facility open 24h?

Contact Person Information

Other Information(for pharmacy)

How Many Employees work at the facility other than the owner?

Is there any other pharmacist available for late night hours?

Does the facility perform Primary care (blood pressure check, etc.)?

Does the facility perform vaccination?

IT Requirements

Which browser do you use?

Do you have a scanner?

Documents to be Enclosed with this Form

Commercial Circular

Copy of License for Practicing Pharmacy in Lebanor

Copy of Company/Corporation Registration Certificate

Copy of Order of Pharmacists Registration Certificate

Copy of Facility License

Copy of Identity Card (s) of the Person (s) Entrust to Sign

Photo of the facility

Bank account details for bank transactions: Bank Name/Brance/IBAN/Account Holder(s) Name(s)/Currency LBP