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Register

Use the form below to register for an account with Lemarchand Dispensary. All new accounts will be reviewed and manually approved by our staff.

Phone

This field is for validation purposes and should be left unchanged.

Pharmacy Name(Required)

Store Number (if applicable)

Pharmacy Address(Required)

Street Address Address Line 2 City Province Postal Code

Pharmacy License Number(Required)

Pharmacy Licensee (Ex. Store Manager)(Required)

Email(Required)

One email address per pharmacy

Phone(Required)

Password(Required)

Enter Password Confirm Password

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