Login/Register
Home
WaferiX
®
Technology
Medicinal CBD
Enquiry
Contact us
FAQ
Register as a Pharmacist
Your Details
First Name
Last Name
Email Address
AHPRA number
Accounts Email
Landline Number
Pharmacy License
Pharmacy License
Support format: PDF/JPG/PNG. Size of file should not be more than 2MB.
I provide my consent to iX Syrinx Pty Ltd to appear on its pharmacy directory for Xativa
®
medicinal cannabis.
Pharmacy Details
Pharmacy name
Pharmacy phone
Street Address Line 1
Street Address Line 2
Suburb
State/Territory
Please select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode
Country
ABN
ABN must contain 11 digits without spacing.
Pharmacy Fax (optional)
Password
Password
Password must contain 8 or more alphanumeric characters.
Confirm Password
I'm happy to receive product updates.
I have read and agreed to the
Privacy Policy
and
Terms of Service
.
Register