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Pharmacy Discontinuance Form

The University of the State of New York THE STATE EDUCATION DEPARTMENT Office of the Professions New York State Board of Pharmacy Purpose of form : The owner or corporate officer of an Instate or Non-resident Pharmacy or Manufacturer/Repacker/Wholesaler must file a Discontinuance form to notify the New York State Board of Pharmacy it has closed its doors and is no longer in business. Discontinuance form Instructions: Complete each section by filling in the blanks and/or putting a check mark in the appropriate box.

Attach this form to the Registration Certificate and submit it along with any other required documentation to the New York State Board of Pharmacy, 89 Washington Avenue, 2nd floor, Albany, NY 12234 Discontinuance Form, May 2016

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