Daniel E. Bluthardt, Director Division of Professional Regulation  
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Rod R. Blagojevich, Governor

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Mailing Address
Springfield Office:
320 West Washington St
Springfield, IL 62786   

Chicago Office:
James R. Thompson Ctr
100 W. Randolph St
Suite 9-300
Chicago, IL 60601   

Telephone
Springfield Office:

(217)785-0800
(217)782-3414 For Real Estate Calls
(217)524-6735 TDD
(217)782-7645 FAX
Chicago:
(312)814-4500

WHOLESALE DRUG DISTRIBUTOR &
097 OTHER CONTROLLED SUBSTANCE LICENSEES



NOTE: PRINT USING BLACK INK ON WHITE PAPER.
COMPLETE THE APPLICATION AND MAIL ALL PAGES
PARTIAL APPLICATIONS WILL NOT BE PROCESSED

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Wholesale Drug Distributor

    THIS PACKET INCLUDES:
    .   Instruction Sheet
    .   Application for Licensure as an Illinois In-State Drug Distributor
    .   Application for Licensure as an Illinois Out-of-State Drug Distributor
    .   CT Drug Distributor Certification by Licensing Agency/Board
    .   Instructions for Controlled Substances Application
    .   Application for Licensure under the Illinois Controlled Substances Act
 
097 Other Controlled Substance Licensees

    THIS PACKET INCLUDES:
    .   Instructions and Application for Controlled Substances Act

    THE CONTENTS OF THIS PACKET APPLIES TO:
       Research and/or Teaching
       Chemical Analysis (Analytical Laboratory)
       Instructional Activity/Universities/Colleges
       Surgical Center/Ambulatory Care
       Clinics
       Animal Shelters/Dog Training
 

 

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