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Form preview Nj application registration fo... If we can be of further assistance please call 973-504-6351. New Jersey Is An Equal Opportunity Employer Printed on Recycled Paper and Recyclable 6/08 Initial Application for Registration for Dispenser/Prescriber P. O. Box 45045 Newark NJ 07101 New Jersey Controlled Dangerous Substances Act N.J.S.A. 24 21-1 et seq. O. Box 45045 Newark NJ 07101 973 504-6351 Controlled Dangerous Substance Registration Instruction sheet Enclosed is a Controlled Dangerous Substance C. D. S. application which you are required to submit pursuant to N.J.S.A. 24 21-1 et seq. Registration is required for every person who or firm that manufactures prescribes distributes dispenses or conducts research or analysis utilizing controlled dangerous substances. New Jersey Office of the Attorney General Division of Consumer Affairs Drug Control Unit 124 Halsey Street 3rd Floor P. O. Box 45045 Newark NJ 07101 973 504-6351 Controlled Dangerous Substance Registration Instruction sheet Enclosed is a Controlled Dangerous Substance C. D. S* application which you are required to submit pursuant to N*J*S*A. 24 21-1 et seq. Registration is required for every person who or firm that manufactures prescribes distributes dispenses or conducts research or analysis utilizing controlled dangerous substances. A New Jersey C. D. S* registration is issued only for a New Jersey location* Be sure to include a 20. 00 check or money order payable to State of New Jersey. It will take 4-6 weeks to process this application* Your C. D. S* registration will be mailed to the mailing address on file with your professional licensing board. Please note 1. If you have a current D. E*A. number in another state and plan to discontinue practice in that state you may transfer that D. E*A. number to New Jersey by providing the following to the Drug Enforcement Administration 80 Mulberry Street Newark New Jersey 07102 888-356-1071 www. deadiversion*usdoj. gov a* b. c* d. a copy of your New Jersey professional license or a verification letter from the licensing board a copy of your out-of-state D. E*A. registration and a letter requesting an address change to the same address that is on your New Jersey C. D. S* registration* A D. E*A. number is only valid in the state listed on the certificate. 2. If you plan to practice in both New Jersey and the state s where you currently hold a D. E*A. registration s you must also obtain a D. E*A. registration for New Jersey. Please contact the D. E*A. at the address indicated above and complete the New Jersey application* 3. In order to complete the attached application please note a* A dispenser/prescriber/ practitioner includes medical doctors doctors of osteopathy dentists optometrists veterinarians and podiatrists. A mid-level dispenser/prescriber/practitioner includes physician assistants advanced practice nurses and certified nurse midwives. Pharmacies must complete a separate application* b. Every person or firm handling controlled dangerous substances in New Jersey is required to have both a state and federal registration for that purpose.

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