PCI

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## Pharmacist registration form (Teacher/Student/Pharmacist)

Already registered to State Pharmacy Council
Profession :
Salutation :
First Name :
Middle Name :
Last Name :
Mobile :
Email ID :
Please use official email address
Pancard No. :
Aadhaar No. :
Upload Pancard :
Upload Aadhaar :
State Pharmacy Council:
×U.P. Pharmacy Council
×
State Pharmacy Council Registration Number :
Upload State Pharmacy Council Certificate :
Pharmacist Address :
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