Louisiana Board of Pharmacy - State of Louisiana

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photo-pharmacist State of Louisiana

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 to 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.
     For paper applications, 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

010-SWP-PST ~ Application for Special Work Permit for Non-licensed Pharmacist

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