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License Applications and Forms
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Pharmacist, Intern, Technician Forms |
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Facility Forms |
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Renewal and Reinstatement Forms
If you received a renewal in the mail, that version is individually bar coded to link your renewal fees with your license number. Please use it. If you did not receive a renewal in the mail, click the link above for a non-bar coded renewal form.
Pharmacists and Pharmacy Technicians: Do not sign or date your renewal form until you have completed your continuing education requirements. This requirement is clear in the text above the signature line on pharmacist and technician renewal forms. CEs completed after the date on your renewal form will be disregarded in an audit. The envelopes and postmark dates used for division correspondence become part of your permanent record.
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Shared Pharmacy Services Application, #08-4566, Revised 01/10/12 |
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Job Shadowing Documentation Form
08-4569, New 01/06/11. New regulation effective 01/29/11.
Refer to 12 AAC 52.250,
Board of Pharmacy Statutes and Regulations. |
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Applications
may be
viewed and printed
with Adobe
Acrobat
Reader
6.0 or
higher. If you
do
not have
Adobe Acrobat
Reader
6.0 or higher,
please
click
on the
Adobe logo and
download
the free
software
now. If
you
are unable
to view
or download
an application,
please
contact us by
telephone
or e-mail.
Providing
your complete
mailing
address will
enable
us to mail
you the
application. Other
application
forms
may be mailed
to you
or picked up
at a
division
office.
Completed applications
must
be signed
and submitted
to the
division with
the
appropriate
fees. |
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