Address & Employment Change

Only pharmacists, interns and technicians may submit address and employment changes online. Pharmacies and Drug Distributors must file a Change of Location application form, which can be found here.

Online changes will not be accepted without a name.

Online changes will not generate a new registration certificate or license automatically.

If you wish a duplicate registration or license issued, you must submit your change request in writing to the Board, along with your written request for a duplicate registration or license, and pay a $20 duplicate issue fee. If you do not request a duplicate, the change will be reflected on your next renewal application.


Name: (Required)
Registration/License # (Required):
Type of Licensure: (Required)
Phone Number:
Email Address:

Previous Address
Street:
City, State, Zip:

Current Address
Street:
Apt #:
City, State, Zip:

Previous Employment
Pharmacy Name:
Pharmacy Lic #: (Required)
Address:
City, State, Zip:

Current Employment
Pharmacy Name:
Pharmacy Lic #: (Required)
Address:
City, State, Zip: