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Iowa Board of Pharmacy

cassie.lee@iowa.gov

400 SW 8th St. Ste E Des Moines, IA 50309-4688

515-281-5944

Precursor Substances Transaction Report

Type of Transaction Reported

Transaction Date

Recipient Address

    Provider Address

      Name of Substance(s) Transferred/Sold

      Business/Activity of Person or Business Reporting

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