Forms - Pharmacists
Application for New Pharmacist License
The Application for New Pharmacist License is available by electronic format (online). To preview the application and review the application checklist visit the Application Process Transparency page. If you require a paper application, you may submit a written request to the Board office for that document.
Start your electronic application(s) at the link provided at the bottom of the page.
033 ~ Professional Credentials Disclosure Form
Paper Applications for New Pharmacist Privileges
010-SWP-PST ~ Application for Special Work Permit for Non-licensed Pharmacist [for disaster relief efforts]
Paper Applications for Renewal Existing Pharmacist License 2026
Available November 1 - December 31.
012 ~ Application for Renewal of Pharmacist License for Year 2026
012-G ~ Application for Renewal of Pharmacist Gold Certificate for Year 2026
012-M ~ Application for Renewal of Military Pharmacist License for Year 2026
012-MS ~ Application for Renewal of Pharmacist License for Military Spouse for Year 2026
012-VI ~ Application for Renewal of Pharmacist License on Voluntary Inactive Status for Year 2026
012-GVI ~ Application for Renewal of Pharmacist Gold Certificate on Voluntary Inactive Status for Year 2026
Application for Reinstatement of Expired Pharmacist License
012-R ~ Application for Reinstatement of Pharmacist License
Wall Certificate Order Forms
204 ~ Product Order Form - Pharmacist's Original Certificate
205 ~ Product Order Form - Pharmacist's Silver Certificate
Retired Forms
The following forms have been retired and are no longer available. Please log into your online services account using the link provided below and select the appropriate link to complete these tasks.
017 ~ Application for New Collaborative Drug Therapy Management (CDTM) Registration
062 ~ Affidavit of Acknowledgement & Acceptance of Responsibility by Pharmacist-in-Charge
091 ~ Notice of Name Change
092 ~ Notice of Pharmacy Employment