1 Identity Details2 Educational and Professional Information Section A: Personal Identification DetailsEmail Address* Prefix*------Select your title------Dr.Mr.Mrs.MissMs.Prof.Maj.Comm.Capt.Col.Gen.First Name*Middle Name (option)Last Name*Suffix (option)------Select your suffix------Jr.Sr.IIIIIIVSection B: Contact InformationAll correspondence will go to this address.Mailing Address (line 1)*Mailing Address (line 2)City*State/Province/Emirate*------Select your State------ALAKAZARAAAEAPCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWYABBCMBNBNLNTNSNUONPEQCSKYTAB (Abu Dhabi)AJ (Ajman)DB (Dubai)FU (Fujairah)RA (Ras al-Khaimah)SH (Sharjah)UM (Umm al-Qaiwain)OtherWrite here*Zip Code/Postal Code*Country*------Select your Country------AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, the Democratic Republic of theCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePhone number* Section C: Education HistoryWhere did you graduate from?United StatesCanadaOtherPharmacy School Name*Country of Pharmacy School*Select your countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwePharmacy School Name*------Select your School------Albany College of Pharmacy and Health Sciences - Albany, NYAlbany College of Pharmacy and Health Sciences - Colchester, VTAppalachian College of Pharmacy College of PharmacyAuburn University Harrison School of PharmacyBelmont University College of PharmacyBinghamton University - SUNY School of Pharmacy and Pharmaceutical SciencesButler University College of Pharmacy and Health SciencesCalifornia Health Sciences University College of PharmacyCalifornia Northstate University College of PharmacyCampbell University College of Pharmacy & Health SciencesCedarville University School of PharmacyChapman University School of PharmacyChicago State University College of PharmacyConcordia University Wisconsin School of PharmacyCreighton University School of Pharmacy and Health ProfessionsD'Youville College School of PharmacyDrake University College of Pharmacy & Health SciencesDuquesne University School of PharmacyEast Tennessee State University Bill Gatton College of PharmacyFairleigh Dickinson University School of PharmacyFerris State University College of PharmacyFlorida A&M University College of PharmacyHampton University School of PharmacyHarding University College of PharmacyHigh Point University School of PharmacyHoward University College of PharmacyHusson University School of PharmacyIdaho State University College of PharmacyKeck Graduate Institute School of PharmacyLake Erie College of Osteopathic Medicine - Bradenton Campus School of PharmacyLake Erie College of Osteopathic Medicine - Distance Education Pathway School of PharmacyLake Erie College of Osteopathic Medicine - Erie Campus School of PharmacyLarkin University College of PharmacyLebanese American University School of PharmacyLipscomb University College of PharmacyLoma Linda University School of PharmacyLong Island University Arnold & Marie Schwartz College of Pharmacy and Health SciencesManchester University Pharmacy ProgramMarshall B. Ketchum University College of PharmacyMarshall University School of PharmacyMassachusetts College of Pharmacy and Health Sciences - Boston, MAMassachusetts College of Pharmacy and Health Sciences - Manchester, NHMassachusetts College of Pharmacy and Health Sciences - Worcester, MAMedical College of Wisconsin Pharmacy SchoolMedical University of South Carolina College of PharmacyMercer University College of PharmacyMidwestern University - Downers Grove Campus College of PharmacyMidwestern University - Glendale Campus College of PharmacyNorth Dakota State University College of PharmacyNortheast Ohio Medical University (NEOMED) College of PharmacyNortheastern University School of PharmacyNotre Dame of Maryland University School of PharmacyNova Southeastern University College of PharmacyOhio Northern University College of PharmacyOregon State University College of PharmacyPacific University Oregon School of PharmacyPalm Beach Atlantic University Lloyd L. Gregory School of PharmacyPhiladelphia College of Osteopathic Medicine - Georgia Campus School of PharmacyPresbyterian College School of PharmacyPurdue University College of PharmacyRegis University School of Pharmacy Rueckert-Hartman College for Health ProfessionsRoosevelt University College of PharmacyRosalind Franklin University of Medicine and Science College of PharmacyRoseman University of Health Sciences College of PharmacyRutgers, The State University of New Jersey College of PharmacySamford University McWhorter School of PharmacyShenandoah University School of PharmacySouth College (TN) School of PharmacySouth Dakota State University College of Pharmacy and Allied Health ProfessionsSouth University (GA) School of PharmacySouth University (SC) School of PharmacySouthern Illinois University Edwardsville School of PharmacySouthwestern Oklahoma State University School of PharmacySt. John Fisher College Wegmans School of PharmacySt. John's University College of Pharmacy and Health SciencesSt. Louis College of Pharmacy College of PharmacySullivan University College of PharmacyTemple University of the Commonwealth System of Higher Education School of PharmacyTexas A&M University Irma Lerma Rangel College of PharmacyTexas Southern University College of Pharmacy and Health SciencesTexas Tech University Health Sciences Center School of PharmacyThe Ohio State University College of PharmacyThe University of Findlay College of PharmacyThe University of Iowa College of PharmacyThe University of Kansas School of PharmacyThe University of Louisiana Monroe School of PharmacyThe University of Mississippi School of PharmacyThe University of New Mexico Health Sciences Center College of PharmacyThe University of North Carolina at Chapel Hill Eshelman School of PharmacyThe University of Oklahoma College of PharmacyThe University of Rhode Island College of PharmacyThe University of Tennessee College of PharmacyThe University of Texas at Austin College of PharmacyThe University of Texas at El Paso School of PharmacyThe University of Texas at Tyler Ben and Maytee Fisch College of PharmacyThe University of Toledo College of Pharmacy and Pharmaceutical SciencesThomas Jefferson University Jefferson School of PharmacyTouro College (NY)College of PharmacyTouro University California College of PharmacyUnion University College of PharmacyUniversity at Buffalo - SUNY School of Pharmacy and Pharmaceutical SciencesUniversity of Arizona College of PharmacyUniversity of Arkansas for Medical Sciences College of PharmacyUniversity of California, San Diego Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of California, San Francisco School of PharmacyUniversity of Charleston School of PharmacyUniversity of Cincinnati The James L. Winkle College of PharmacyUniversity of Colorado School of PharmacyUniversity of Connecticut School of PharmacyUniversity of Florida College of PharmacyUniversity of Georgia College of PharmacyUniversity of Hawaii at Hilo The Daniel K. Inouye College of PharmacyUniversity of Houston College of PharmacyUniversity of Illinois at Chicago College of PharmacyUniversity of Kentucky College of PharmacyUniversity of Maryland School of PharmacyUniversity of Maryland Eastern Shore School of PharmacyUniversity of Michigan College of PharmacyUniversity of Minnesota College of PharmacyUniversity of Missouri-Kansas City School of PharmacyUniversity of Montana Skaggs School of PharmacyUniversity of Nebraska Medical Center College of PharmacyUniversity of New England College of PharmacyUniversity of North Texas Health Science Center System College of PharmacyUniversity of Pittsburgh School of PharmacyUniversity of Puerto Rico School of PharmacyUniversity of Saint Joseph School of PharmacyUniversity of South Carolina College of PharmacyUniversity of South Florida School of PharmacyUniversity of Southern California School of Pharmacy John Stauffer Pharmaceutical Sciences CenterUniversity of the Incarnate Word Feik School of PharmacyUniversity of the Pacific Thomas J. Long School of Pharmacy and Health SciencesUniversity of the Pacific - Pre-Pharmacy Advantage ProgramUniversity of the Sciences in Philadelphia College of PharmacyUniversity of Utah College of PharmacyUniversity of Washington School of PharmacyUniversity of Wisconsin - Madison School of PharmacyUniversity of Wyoming School of PharmacyVirginia Commonwealth University School of PharmacyWashington State University College of PharmacyWayne State University College of PharmacyWest Coast University School of PharmacyWest Virginia University School of PharmacyWestern New England University College of PharmacyWestern University of Health Sciences College of PharmacyWilkes University Nesbitt School of PharmacyWingate University - Hendersonville, NC School of PharmacyWingate University - Wingate, NC School of PharmacyXavier University of Louisiana College of PharmacyOtherWrite here*Pharmacy School Name*------Select your School------Dalhousie University College of PharmacyMemorial University of Newfoundland School of PharmacyUniversité de Montréal Faculté de pharmacieUniversité Laval Faculté de pharmacieUniversity of Alberta Faculty of Pharmacy & Pharmaceutical SciencesUniversity of British Columbia Faculty of Pharmaceutical SciencesUniversity of Manitoba Faculty of PharmacyUniversity of Saskatchewan College of Pharmacy and NutritionUniversity of Toronto Leslie Dan Faculty of PharmacyUniversity of Waterloo School of PharmacyOtherWrite here*Section D: Work ExperienceOrganization Name*Job Title*City*State/Province/Emirate*-----Choose your state-----ALAKAZARAAAEAPCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWYABBCMBNBNLNTNSNUONPEQCSKYTAB (Abu Dhabi)AJ (Ajman)DB (Dubai)FU (Fujairah)RA (Ras al-Khaimah)SH (Sharjah)UM (Umm al-Qaiwain)OtherWrite here*Country*-----Choose your Country-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweWork Email (option) Work Phone Number (option)Section D: BiographyEnter your biography. Alternatively, you can post your LinkedIn, Wikipedia, Organization or University profile pages.*Section E: Licensing InformationCountry*Please select your countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweState(s) of Licensure*Please select your StateALAKAZARAAAEAPCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYABBCMBNBNLNTNSNUONPEQCSKYTAB (Abu Dhabi)AJ (Ajman)DB (Dubai)FU (Fujairah)RA (Ras al-Khaimah)SH (Sharjah)UM (Umm al-Qaiwain)OtherLicense Number(s)*