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Forms & Applications
Pharmacy Interns
020 ~ Application for New Pharmacy Intern Registration (updated 08/20)
021 ~ Pharmacist's Certification of Hours of Professional Experience Earned by Pharmacy Interns WITHIN Louisiana
022 ~ Pharmacist's Certification of Hours of Professional Experience Earned by Pharmacy Interns OUTSIDE Louisiana
019 ~ Application for New Medication Administration Registration (updated 2020-0701)
090 ~ Notice of Change in Mailing Address
091 ~ Notice of Name Change
092 ~ Notice of Pharmacy Employment
150 ~ Application for Therapeutic Marijuana (TM) Designation
201 ~ Product Order Form - Duplicate Credential
203 ~ Product Order Form - Louisiana Pharmacy Law Book
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Louisiana Board of Pharmacy | 3388 Brentwood Drive | Baton Rouge, La. 70809 | Phone: (225) 925-6496 | Fax: (225) 925-6499 | Email Us | Report Fraud
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