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Get Fee: $400 For Osbp Use Only: License Issued Replaces Reset Form Information May Be Typed In Before

The form. OKLAHOMA STATE BOARD OF PHARMACY 4545 Lincoln Blvd., Suite 112, Oklahoma City, OK 73105-3488 Phone: (405) 521-3815 / Fax: (405) 521-3758 www.pharmacy.ok.gov / e-mail: pharmacy pharmacy.ok.gov IN-STATE MANUFACTURER, PACKAGER OR WHOLESALER PERMIT APPLICATION 1. List name and/or dba and street address of facility: 3. Check one: NEW 2. Mailing address: CHANGE ( Ownership / Name / Location) Please allow 2-3 weeks for processing of your license and physical inspection of your.

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