SAMPLE Application Form (2025 Registration Renewal)

2025 REGISTRATION RENEWAL APPLICATION

Premises Number – Registration Number

Pharmacy – Pharmacy Name

Pharmacist with overall responsibility – Responsible Pharmacy

[Refer Pharmacy Regulations 2010, Regulation 6 – Renewal of registration]

The Pharmacy Registration Board of Western Australia (the Board) is established under the Pharmacy Act 2010 (the Act).

Location: Level 4 130 Stirling Street Perth 6000 Western Australia

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