Forms & Applications

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. 

To start your application, click here.

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 2024

Available November 1 - December 31. 

012 ~ Application for Renewal of Pharmacist License for Year 2025

012-G ~ Application for Renewal of Pharmacist Gold Certificate for Year 2025

012-M ~ Application for Renewal of Military Pharmacist License for Year 2025

012-MS ~ Application for Renewal of Pharmacist License for Military Spouse for Year 2025

012-VI ~ Application for Renewal of Pharmacist License on Voluntary Inactive Status for Year 2025

012-GVI ~ Application for Renewal of Pharmacist Gold Certificate on Voluntary Inactive Status for Year 2025

 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 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