9-20-23 CEU Form

Name
First Last
Street Address*
City*
State*
Zip*
Phone*
Email*
Profession Type*
License Number*
(FL Pharmacists: include PS number only)
For pharmacists/pharmacy techs*
If you would like your hours reported to NABP, please include your profile number
Date of Birth (MM/DD)*

Please include your DOB
Did the speaker achieve the goals and objectives provided for this program?*
Will the information presented benefit you in your daily practice?*
Additional comments
Please share any additional information you’d like to share from your participation in this activity.

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