Minimum information required for registration as a wholesaler

The following information shall be required for each application for a registration or a renewal of a registration: (1) The name, full business address, and telephone number of the registrant; (2) All trade or business names used by the registrant; (3) Addresses, telephone numbers, and the names of contact persons for all facilities used by the registrant for the storage, handling, and distribution of prescription drugs; (4) The type of ownership or operation (i.e., partnership, corporation, or sole proprietorship); (5) The name(s) of the owner and/or operator of the registrant, including: (A) If a person, the name of the person; (B) If a partnership, the name of each partner, and the name of the partnership; (C) If a corporation, the name and title of each corporate officer and director, the corporate name, and the name of the State of incorporation; and (D) If a sole proprietorship, the full name of the sole proprietor and the name of the business entity; (6) An indication as to whether the registrant will distribute controlled substances, legend drugs and/or over the counter drugs as well as a statement concerning the types of drugs to be distributed; and (7) A change in any information in this section shall be submitted to the Commissioner within 30 days of such change.