Forms / Applications

Pharmacists

Affidavit of Acknowledgement and Acceptance of Responsibility by Pharmacist-in-Charge

Application for Pharmacist License by Examination or Score Transfer

Application for Pharmacist License by Reciprocity

Application for Renewal of Pharmacist License

Complaint Form

Donor Consent Form

Notification of Change of Mailing Address or Employment

Notification of Change of Name

Notification of Change of Pharmacist-in-Charge

Order Form for Original Pharmacist Certificate

Order Form for Pharmacist Silver Certificate

Order Form for Replacement of Original Pharmacist Certificate

Request for Duplicate Renewal

Voluntary Surrender of License

Pharmacy Interns

Application for Pharmacy Intern Registration

Complaint Form

Donor Consent Form

Notification of Change of Mailing Address or Employment

Notification of Change of Name

Request for Duplicate Registration

Voluntary Surrender of Registration
Preceptor’s Affidavit for Certifying Hours for Pharmacy Intern

Preceptor’s Affidavit for Certifying Hours for an Out of State Pharmacy Intern
 

Pharmacy Technician Candidates

Application for Pharmacy Technician Candidate Registration

Complaint Form

Donor Consent Form

Notification of Change of Mailing Address or Employment

Notification of Change of Name

Request for Duplicate Registration

Voluntary Surrender of Registration
Preceptor’s Affidavit for Certifying Hours for Pharmacy Technician

Pharmacy Technicians

Application for Pharmacy Technician Certificate

Application for Renewal of Technician Certificate

Complaint Form

Donor Consent Form

Notification of Change of Mailing Address or Employment

Notification of Change of Name

Order Form for Replacement of Original Technician Certificate

Request for Duplicate Renewal

Voluntary Surrender of Certificate
Preceptor’s Affidavit for Certifying Hours for Pharmacy Technician

Pharmacies

Affidavit of Acknowledgement and Acceptance of Responsibility by Pharmacist-in-Charge

Application for Automated Medication System Permit

Application for Emergency Drug Kit Permit

Application for Out-of-State Pharmacy Permit

Application for Pharmacy Permit and CDS License

Application for Renewal of Automated Medication System Permit

Application for Renewal of Emergency Drug Kit Permit

Application for Renewal of Out-of-State Pharmacy Permit

Application for Renewal of Pharmacy Permit and CDS License

Complaint Form

Notification of Change of Pharmacist-in-Charge

Notification of Closure of Pharmacy Permit
Application for Relocation of a Louisiana Pharmacy Permit
Request for Duplicate Renewal

Other Forms

Order Form for Law Book

Order Form for Official Mailing List