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California State Board of Pharmacy 2720 Gateway Oaks Drive, Ste. 100 Sacramento, CA 95833 Phone: (916) 5183100 Fax: (916) 5748618 www.pharmacy.ca.govBusiness, Consumer Services and Housing Agency

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Submit the completed form along with any required fees or additional documents to the California State Board of Pharmacy either by mail or electronically, as specified in the instructions.

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