- For Consumers
- For Pharmacists
- For Pharmacies
- For Pharmacy Technicians & Technician Candidates
- For Pharmacy Interns
- (CDS) Controlled Dangerous Substance Licenses
- (PMP) Prescription Monitoring Program
- (DME) Durable Medical Equipment Providers
Forms & Applications
Pharmacists
010 ~ Application for New Pharmacist License by Examination or Score Transfer
011 ~ Application for New Pharmacist License by Reciprocity
012 ~ Application for Renewal of Pharmacist License for Year 2013
012-L ~ Application for Late Renewal of Pharmacist License for Year 2013
012-G ~ Application for Renewal of Pharmacist Gold Certificate for Year 2013
012-G-L ~ Application for Late Renewal of Pharmacist Gold Certificate for Year 2013
012-GVI ~ Application for Renewal of Pharmacist Gold Certificate on Voluntary Inactive Status for Year 2013
012-M ~ Application for Renewal of Military Pharmacist License for Year 2013
012-VI ~ Application for Renewal of Pharmacist License on Voluntary Inactive Status for Year 2013
017 ~ Application for Collaborative Drug Therapy Management (CDTM) Registration
019 ~ Application for New Medication Administration Registration
026 ~ Application for Renewal of Medication Administration Registration
090 ~ Notice of Change of Mailing Address or Employment
091 ~ Notice of Change of Name
201 ~ Product Order Form - Duplicate Credential
204 ~ Product Order Form - Pharmacist's Original Certificate
205 ~ Product Order Form - Pharmacist's Silver Certificate
Note: If your license has been expired for more than 30 days, it is too late to renew it. However, you can apply for the reinstatement of the license. To do so, please send a written request to the Board office (mail, fax, or email), requesting the information necessary to reinstate your license. Please be sure to include your name, license number, and current mailing address. The licensing staff will prepare a reinstatement packet for you, containing instructions on the procedures necessary to reinstate your license.
