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Ncbop.org AUTHORIZATION FOR CREDIT CARD CHARGE THE NC BOARD OF PHARMACY ONLY ACCEPTS PAYMENT VIA VISA MASTERCARD DISCOVER OR AMERICAN EXPRESS. WE DO NOT ACCEPT CHECKS. FEE FOR NEW DME PERMIT TRANSFER OF OWNERSHIP OR RE-REGISTRATION IS 500. A PIC CAN ONLY BE ASSIGNED TO ONE DME PERMIT. Rev Oct 2016 North Carolina Board of Pharmacy Print Form 6015 Farrington Road Suite 201 Chapel Hill North Carolina 27517 Phone 919 246-1050 Fax 919 246-1056 www. ITEM 1 DME NAME BUSINESS ADDRESS REQUIRED ITEM 2...
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Application for registration is a form used to officially register for a particular program or service.
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