Resident In State Pharmacy
Change of Location
- Complete Endorsement Application (PH 202 32 KB)
- Complete Pharmacy Information Form (PH
Part II (page 3) of this form requires a diagram of
- Please indicate the size of the Compounding and Dispensing area and the Registered Area. Fill in the blank spaces.
- Indicate the placement of the sink and refrigerator in red ink.
- Outline the registered area in one color of highlighter and indicate the compounding and dispensing area in another color of highlight or red ink.
- Part II (page 3) of this form requires a diagram of the establishment:
- Check or Money Order for $50 payable to the New York State Education Department
In addition, submit the following:
- Lease or deed for the premises made out to the registered name of the corporation or LLC.
- Assignment of lease for the premises where applicable to the name of the corporation or LLC you are registering.
- Certificate of Occupancy for the premises.
- Photographs: (Staple all photos to 8½ by 11 typing
paper. Please do not send multiple photos of the same
thing or same angle.)
- Photo of outside signs on the building. We must be able to read the signs.
- Photo of front exterior showing the registered name of the corporation or LLC on the exterior. We must be able to read the sign.
- If the pharmacy is a department. Include
photos of the department with the gates open and closed.
- Final Prescription Label with registered name of the corporation of LLC and new address.
You will be notified by mail regarding the inspection at the new location.