Information Change

Established 1903

You Are Here:

This request is for (check all that apply):

		Change of Address
		Change of Employment / PIC (Pharmacist in Charge)

Please fill in all fields of the appropriate section below and click "Submit" when you are done.

Change of Address
Name
License No.
Phone
Date of Birth
Address
City
State
Zip
County


Change of Employment / PIC (Pharmacist in Charge)
Name
License No.
Pharmacy
Address
City
State
Zip
County
		Yes, I am the PIC
		No, I am not the PIC


Comments (750 char limit)

Email
	Enter Security Code:

License / Permit Verification

License / Permit Online Applications

NOTICE FOR RENEWALS:

IF YOUR LICENSE OR PERMIT IS EXPIRED, DO NOT APPLY FOR A NEW LICENSE OR PERMIT - THIS WILL ONLY DELAY YOUR RENEWAL.

Effective Monday, November 7th, 2011, renewals will only be payable by check, money order or cash (exact change) - no credit or debit cards.

You must renew your expired license or permit by mail or in person, using one of the forms listed below:

License Renewal Form
(for individuals) (PDF)

Permit Renewal Form
(for facilites) (PDF)

Renewal Fee Chart
(PDF)