COMMONWEALTH OF MASSACHUSETTS

SUFFOLK COUNTY	BOARD OF REGISTRATION

IN PHARMACY

____________________________________

)

In the Matter of	)

Shala Johnson	) Docket No.2010-0165

Reg. No. 7344 (exp. 12/12/2010)	)

)

VOLUNTARY SURRENDER STATEMENT

I, Shala Johnson (Reg. No. 7344), do voluntarily surrender my license to practice as a pharmacy

technician 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 pharmacy technician in the

Commonwealth of Massachusetts (Reg. No. 7344) 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. 2010-0165 (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 hearing pursuant to

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

4. I will surrender any current license or registration to practice as a pharmacy technician 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 pharmacy technician or to renew any pharmacy technician

license previously issued by any other jurisdiction prior to entering into an agreement with the

Board in resolution of the Complaint; and

5. 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 4th day of October, 2010.

Shala Johnson

[redacted]

COMMONWEALTH OF MASSACHUSETTS

Gentle, Mallory (DPH)

2017-10-03