Forms
NOTE: Board staff recommends submitting these forms electronically to [email protected], as paper applications and forms take longer to process.
| License Specific Forms | Last Revision |
| Immunization Application | 05.12.2022 |
| Intern - Hours Report | 10.22.2015 |
| Pharmacist - 2024 Renewal (Use this application starting September 3, 2024) | 08.27.2024 |
| Technician - 2024 Renewal (Use this application starting September 3, 2024) | 08.27.2024 |
| Technician - Reinstatement Application | 05.17.2023 |
| Verification Of Licensure Form | 03.21.2023 |
| Miscellaneous License Forms | |
| Discipline Acknowledgement | 12.03.2019 |
| Duplicate / Replacement Request | 03.14.2024 |
| Fee Waiver Request | 10.26.2017 |
| Name Change Request | 03.14.2024 |
| NAPLEX / MPJE Petition form | 04.12.2019 |
| Request for License / Permit data | 05.20.2022 |
| Termination of Employment | 05.20.2022 |
| Verification of Licensure | web link |