Pharmacy Permit Application

Select Different Permit

This form is used by a pharmacist who is registered with the Nova Scotia College of Pharmacists and requires alcohol for the purpose of compounding medicines or as a solvent or preservative. Operations are to comply with the Province of Nova Scotia Liquor Control Act, Regulations and Policy Guidelines.

Please note that permits expire annually on December 31

Applicant Information

Name

Title

Address Line 1

Address Line 2

City

Postal Code

Province

Country

Primary Phone

Secondary Phone

Alcohol Requirements

Yearly quantity of pure alcohol required

Quantity Litres

Usage

Purchasing Store

Pharmacist Information

List of registered pharmacists

Add

Name

Remove

Declaration Information

I understand and acknowledge that the information provided by me on this Application is true, complete and correct, to the best of my knowledge and belief. I understand that a false statement may be considered sufficient reason to withhold or cancel the issuance of my Permit(s).

I also understand that by issuance of this Permit, my responsibility and obligation to adhere to the Nova Scotia Liquor Control Act, Regulations, and Policies & Procedures as well as any special conditions and changes which may, from time to time, occur.

I declare that I am at least 19 years of age.

Check this box to accept the declaration.

Select Payment Type

The application fee can be paid by cheque, money order, cash or credit card. Cash transactions can only be made in person at the Head Office.

Credit Card

Cheque or Money Order

Cash