NEVADA FORM HELP
What to know about this form
The Nevada pharmacy application affidavit must include specific declarations and certifications as required by the Nevada State Board of Pharmacy. The affidavit serves as the applicant's legal certification that all information in the pharmacy application is accurate, complete, and compliant with Nevada pharmacy regulations.
Required Affidavit Components:
- Statement of applicant identity and relationship to the pharmacy (owner, corporate officer, managing pharmacist)
- Certification that applicant has authority to sign on behalf of the pharmacy
- Attestation that all pharmacy application information is true and accurate
- Confirmation of pharmacy ownership structure and financial responsibility
- Statement of managing pharmacist qualifications and licensure status
- Certification of compliance with Nevada pharmacy regulations (NAC 639)
- Declaration regarding inventory control and security systems
- Attestation regarding pharmacy operations and professional standards
- Statement of understanding that false information constitutes perjury
Notarization Requirement:
The pharmacy application affidavit must be signed before a Nevada-commissioned notary public. The notary verifies the signer's identity through government-issued photo ID, witnesses the signature, and completes the notarial certification. The notary's seal and signature make the document legally valid for submission to the Nevada State Board of Pharmacy.
✅ Best Practice:
Ensure all pharmacy application fields are completed accurately BEFORE scheduling notarization. Lake Mead Mobile Notary provides pharmacy application notarization at Henderson, business districts, and throughout Clark County with verification of proper affidavit completion and compliance with State Board requirements.
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