Basic Information
Name
*
Email
*
Phone
*
Password
*
Your password must be at least 8 characters long, contain at least one uppercase letter, one lowercase letter, one number, and one special character (e.g., @$!%*?&).
Password Confirmation
*
Pharmacy Logo
*
Pharmacy Information
Manger/ Owner name
*
Phone
province
*
Choose province
British Columbia
Alberta
TEST
City
*
Address
*
Postal Code
*
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