Registration Requirements : Renewals : Disp Phys LOGIN : New Disp Phys Reg Application : Disp Phys Reinstatement Application : PA/NP LOGIN : New PA/NP Reg Application : PA/NP Reinstatement Application :Verify Disp Phys or PA/NP Registration

Forms, Applications and Instructions for Dispensing Physicians, Physician Assistants, and Nurse Practitioners



2013 Dispensing Physician Registration Application

Dispensing Physician Reinstatement Application

2013 Physician Assistant/Nurse Practitioner Registration Application

Physician Assistant/Nurse Practitioner Reinstatement Application

Credit Card Authorization Form



For questions about Dispensing Physician or PA/NP registration, please contact Debbie Stump at 919.246.1050 ext. 223 or by email at