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Your Name
Pharmacy name
Pharmacy address
Your Email Address
Contact telephone number
Are you the pharmacy owner? If yes, please tick the box
Please confirm if you are:
Sole trader
Partnership
Limited company
Please provide us with your Companies House number (if applicable). (optional)
Are you purchasing a Lloyds Pharmacy?
Do you already own the pharmacy or are you in the process of purchase?
Are you currently open for business, or when is your anticipated opening date?
GPhC number
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Please read these important PDFs before joining:
Terms and Conditions
Numark Membership Agreement
