COMMONWEALTH OF MASSACHUSETTS

SUFFOLK COUNTY	BOARD OF REGISTRATION IN PHARMACY

In the Matter of

Debra L. Bango, R.Ph.

Reg. No. 20506

(exp. 12/31/2010)

Docket No.2010-0083

VOLUNTARY SURRENDER STATEMENT

I, Debra L. Bango, R.Ph. (Reg. No. 20506), do voluntarily surrender my license to practice as a pharmacist in the Commonwealth of Massachusetts to the Board of Registration in Pharmacy (Board) and do state to the Board:

1. I hereby voluntarily surrender my license to practice as a pharmacist in the Commonwealth of

Massachusetts (Reg. No.20506) together with any right to renew my license, to the Board,

effective as of the date of my signature hereto;

2. I acknowledge and agree that I have surrendered my license to the Board in resolution of

Complaint Docket No. 2010-0083 (Complaint);

3. I understand that surrender of my license is considered to be a reportable disciplinary act

which deprives me of all privileges of registration; that my surrender is not subject to

reconsideration or judicial review; and that I am waiving my right to a bearing pursuant to

G.L. c. 30A regarding the Complaint;

4. I will surrender any current license or registration to practice as a pharmacist issued by any

other jurisdiction effective as of the date of my signature hereto and will not apply or

attempt to gain licensure as a pharmacist or to renew any pharmacist license previously

issued by any other jurisdiction prior to entering into an agreement with the Board in

resolution of the Complaint; and

I acknowledge that I have been provided the opportunity to consult legal counsel

regarding my decision to execute this statement and surrender my license and that my

decision to execute this statement and surrender my license was made of my own free

will.

SIGNED UNDER THE PAINS AND PENALTIES OF PERJURY this 2nd day of June 2010.

Debra L. Bango

[redacted]

Dec. ID No. 2346

COMMONWEALTH OF MASSACHUSETTS

Gentle, Mallory (DPH)

2017-09-27