Forms & Applications
Pharmacists
Application for New Pharmacist License
For online applications, please select this link to the web portal page on our secure server.
> To apply for your second or subsequent credential issued by the Board, please follow the instructions in the first paragraph of the web portal page and log into your existing account.
> To apply for your first new credential issued by the Board, you must first create an account; to do so, please follow the instructions in the second paragraph of the web portal page.
If you prefer to use paper application forms, please select the appropriate link below:
010 ~ Application for New Pharmacist License
010-NR ~ Certification of Graduation from ACPE-Accredited College/School of Pharmacy Located Outside Louisiana (for use by graduates from other states seeking licensure by examination or score transfer, but not by license transfer or reciprocity)
Applications for New Pharmacist Privileges
017 ~ Application for New Collaborative Drug Therapy Management (CDTM) Registration
019 ~ Application for New Medication Administration Registration
062 ~ Affidavit of Acknowledgement & Acceptance of Responsibility by Pharmacist-in-Charge
150 ~ Application for Therapeutic Marijuana (TM) Designation
Applications for Renewal of Existing Pharmacist License
012 ~ Application for Renewal of Pharmacist License for Year 2021
012-L ~ Application for Late Renewal of Pharmacist License for Year 2021
012-G ~ Application for Renewal of Pharmacist Gold Certificate for Year 2021
012-G-L ~ Application for Late Renewal of Pharmacist Gold Certificate for Year 2021
012-M ~ Application for Renewal of Military Pharmacist License for Year 2021
012-M-L ~ Application for Late Renewal of Military Pharmacist License for Year 2021
012-MS ~ Application for Renewal of Pharmacist License for Military Spouse for Year 2021
012-MS-L ~ Application for Late Renewal of Pharmacist License for Military Spouse for Year 2021
012-VI ~ Application for Renewal of Pharmacist License on Voluntary Inactive Status for Year 2021
012-VI-L ~ Application for Late Renewal of Pharmacist License on Voluntary Inactive Status for Year 2021
012-GVI ~ Application for Renewal of Pharmacist Gold Certificate on Voluntary Inactive Status for Year 2021
Applications for Renewal of Existing Pharmacist Privileges
026 ~ Application for Renewal of Medication Administration Registration
Forms for General Use
090 ~ Notice of Change in Mailing Address
091 ~ Notice of Name Change
092 ~ Notice of Pharmacy Employment
204 ~ Product Order Form - Pharmacist's Original Certificate
205 ~ Product Order Form - Pharmacist's Silver Certificate
