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Any business in the Commonwealth of Pennsylvania who is manufacturing, distributing or retailing drugs, medical devices and/or medicated cosmetics must register with the Pennsylvania Department of Health unless otherwise noted as a designated exemption.
continued on the back. Delegating and supervising physician: Name License No. Address. Advanced practice registered nurse (APRN) or physician assistant (PA) to whom prescriptive authority is being delegated. pursuant to this agreement: Name License No. Address. Nature of practice (primary care, OB-Gyn) Practice location(s) The following types or categories of drugs or devices may be prescribed: