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Prefix:
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First Name:
Middle Name:
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Last Name:
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Degree:
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Specialty:
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CMS/Federal
Case Manager
Care Manager
Employer/Employer Consultant
Health Economics/Pharmacoeconomics
Health Care Policy
Health Care Quality
HIT
Medical Director
Nurse
Nurse Practitioner
Pharmacist
Pharmacy Director
Physician
Physician Assistant
Specialty Pharmacist
Other
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Type of credit: (please check each type of credit you may be interested in)
CME
CNE
CPE
VOICE
Non-physician
Social work
ADA
Case Manager
The NABP e-Profile ID and DOB are required for pharmacists only. The information will be used to report credits to the CPE Monitoring System.
NABP e-Profile ID:
For Pharmacists Only, Required to Receive Credit
DOB (MMDD format):
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For Pharmacists Only, Required to Receive Credit
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Title:
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Affiliation:
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Country:
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