Louisiana Board of Pharmacy

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Forms & Applications

Pharmacists

 

010 ~ Application for New Louisiana Pharmacist License

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.