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Regulated ProfessionsPharmacistsApplications and Forms

The forms listed below are fillable forms. Open the form, type the application information, and print. You should then sign the form and have notarized, if applicable. If your computer does not allow completion of the form online, you may print the blank form and complete the application information in black ink.

The Missouri State Highway Patrol (MSHP) and FBI have changed their criminal history background check fees. Effective 10/1/07, the fingerprinting fee is $52.20. Specific portions of the fee are paid to MSHP, FBI and Integrated Biometric Technology (IBT); the Board does not receive any portion of the fingerprinting fee.

PHARMACY TECHNICIAN
Pharmacy Technician Registration Application

INTERN
Intern Pharmacist Licensure Application
Intern Instruction Sheet
Intern Notice of Employment or Change of Preceptor
Intern Training Approved Special Sites
Preceptor's Affidavit of Internship Hours

PHARMACIST
Application for Preliminary Evaluation of Foreign Pharmacy School Graduate
Foreign Graduate Instruction Sheet
Pharmacist Examination Application
Pharmacist Licensure Transfer (Reciprocity)
Temporary Pharmacist License Application

PHARMACY
Class J - Shared Services Questionnaire
Inspection Criteria Forms
Non-Resident Pharmacy/Pharmacist License Verification Affidavit
Out of Business Notification
Pharmacy Classification Change Application
Pharmacy Location Change Application
Pharmacy Name Change Application
Pharmacy Permit Application (Missouri facility)
Pharmacy Permit Application (Non-resident facility)
Pharmacist-in-Charge Change Application

DRUG DISTRIBUTOR
Drug Distributor Name Change Application
Drug Distributor Location Change Application
Drug Distributor License Application--Missouri facility
Drug Distributor License Application--Out-of-State facility
Drug Distributor Out of Business Notification
Drug Distributor License Verificaton Affidavit
Drug Manufacturer Registrant Application
Manager-in-Charge Change Application--Missouri facility
Manager-in-Charge Change Application--Out-of-State facility

MISCELLANEOUS
Application for Approval of Pharmacist Continuing Education Program
Continuing Education Program Instruction Sheet
Duplicate License Request
Intern Training Pharmacy Special Site Application
Licensee Report of Discipline Compliance

 

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mo.gov | difp.mo.gov ]
 

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