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mediCare
📝 Pharmacy Registration
Register your pharmacy to join our network.
🏥 Pharmacy Information
Pharmacy Name
*
Pharmacy Email Address
*
Phone Number
*
License Number
*
Registration Authority
*
Years in Operation
Date Registered
Owner/Manager Full Name
*
Owner/Manager Gender
Select Gender
Male
Female
Other
Contact Person's Phone
*
📍 Address & Location
Physical Address
*
City / Town
*
Country
*
Postal Code
Google Maps Link (Optional)
Latitude (Optional)
Longitude (Optional)
⏰ Operating Details
Opening Days
Opening Hours
Emergency / 24-Hour Service
Online Orders Supported
Delivery Available
Service Areas
📄 Document Uploads
Pharmacy License / Permit
*
No file selected
Owner’s ID / CAC Certificate
*
No file selected
Store Front Photo (Optional)
No file selected
Interior/Storage Photo (Optional)
No file selected
🔒 Login Credentials
Username
*
Email Address
*
Password
*
Confirm Password
*
Register Pharmacy
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