Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
Application Status Query
Instructions:
Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.
Please verify the checklist information below, including your address. If your address has changed, please
e-mail
your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.
As of
:
03/19/2003
Application#
:
164507
Name
:
LHO Pharmacy
Profession
:
Pharmacy (in state)
Address
:
Oshkosh, WI
Application Status
:
(Permanent license issued)
Requirements Not Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Requirements Met:
Description
Status
Comments (Please note, not all requirements will include comments)
Type of License
Met
Applicant Address of Distributor Facility
Met
Owner Partners Corporate Officers, titles, etc
Met
Date of Purchase Proposed Opening Date
Met
May 15, 2003
Barrier Requested?
Met
Pharmacy Hours Daily Saturday Sunday
Met
Employee schedule - be specific
Met
Managing Pharmacist Affidavit and License #
Met
Inspection Ready Date (self inspection will be used)
Met
May 15th 2003
Affidavit of applicant, signed
Met
Application Fee
Met
$
Floor plan - original (scaled to size, location of sink and refrigerator with prescription counter space clearly indicated)
Met
Federal Employer Identification Number Collection (Form #2380)
Met
Self-Inspection (This will not be mailed until application is completed.)
Met
Submit Request to DEA (for your info only)
Met
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Application Status
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