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Official Website

of the Commonwealth of Pennsylvania

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    Applications and Forms

    APPLY ONLINE for the following license types:

    • Pharmacist by Examination, Score Transfer or Reciprocity
    • Authorization to Administer Injectables
    • Reactivation Expired/Inactive Pharmacist
    • Reactivation Expired/Inactive Authorization to Adminster Injectable  Medications, Biologicals and Immunizations

    Initial Licensure

    Verification of Opioid Education Form (PDF)

    Licensure by Reciprocity Information (PDF)

    Authorization to Administer Injectable Medications, Biologicals and Immunizations – Certification of Professional Liability Insurance (PDF)

    Special Notice - Act 8 - AAI Professional Liability Insurance Requirement (PDF)

    Information for Graduates of Foreign Pharmacy Schools (PDF)

    Approved CPR Providers for Authorization to Administer Injectables (PDF)

     

    Reactivation 

    The reactivation applications have been moved to an online process. To review the requirements and submit your reactivation application online login to your account at www.pals.pa.gov and click the pencil icon next to your license number to start the reactivation process.

    Certification of Education and Training for the Reactivation of the Authorization to Administer Injectables for Pharmacists Whose Authorization Expired 2 or More Years Ago and Who Completed a New Training Program Other than the APhA's Pharmacy-Based Immunization Delivery Certificate Program (PDF)

     

    Forms

    Verification of National Exam Score to NABP (PDF)

    Online Verification of License (Pharmacist)

    Change of Name and/or Address

    Management of Drug Therapy - Professional Liability Insurance for the Institutional Setting (PDF)

    Management of Drug Therapy - Professional Liability Insurance for the Non-Institutional Setting (PDF)

    APPLY ONLINE for the following registration:

    • Pharmacy Intern
    • Authorization to Administer Injectables for a Pharmacy Intern

    Pharmacy Intern

    Change or Add a Pharmacist Preceptor (PDF)

    Non-Traditional Internship Preceptor Approval (PDF)

     

    Forms

    Intern Experience Reporting (PDF) - During the COVID-19 pandemic, please scan your form and attach it to a ticket that you create.  Log in to your PALS account at www.pals.pa.gov and click on the comment bubble located to the right of your pharmacy intern registration number under the "Professional License Details" banner.  You may also create a ticket by clicking on the "Support" link on the top blue banner at www.pals.pa.gov.  The Board office staff will respond to your ticket.  Do NOT mail the form/submit a postcard.

    Request Verification of Intern Hours (PDF)

    Online Verification of Intern Registration (Intern)

    Change of Name and/or Address

    Pharmacy

    Nonresident Pharmacy

    Nonresident Pharmacy Application for a Change in Location, Change in Ownership or Change in Title (PDF)

    • The proposed nonresident pharmacy application is now available online at www.pals.pa.gov  (click here for helpful information)

    Change in Pharmacist in Charge (PDF)

    • The reactivation application has been moved to an online process. To review the requirements and submit your reactivation application online login to your account at www.pals.pa.gov.

    Pharmacy Located in Pennsylvania

    The proposed Pennsylvania pharmacy application is now available online at www.pals.pa.gov  (click here for helpful information)

    Change in Title (PDF)

    Change in Ownership/Controlling Interest (PDF)

    9-1-1 Address Change for a Pharmacy (PDF)

    Central Processing Center Pharmacy Application (PDF)

    Satellite Pharmacy (PDF)

    The Pennsylvania Change in Location, Pharmacy Remodel and Change in Pharmacist Manager (Within an Established Pharmacy) applications are now online available at www.pals.pa.gov.

    • Please log into the pharmacy's PALS account at this website, 
    • Close out the PALS tips, 
    • Scroll down to the "Professional License Details" banner
    • Click on the pencil icon located to the left of the pharmacy's license number
    • The pencil icon will provide you with several options; choose the appropriate option to proceed to the change in location, remodel or change in pharmacist manager application.

    Cancer Drug Repository Program  

    The Department encourages all licensed facilities to consider joining the CDRP, making safe and affordable treatment available to your customers. Learn more about the CDRP.

    Forms

    Pharmacy Closure Notice (PDF)

    Forms (All)

    Approved CPR Providers for Authorization to Administer Injectables (PDF)

    Change of Name and/or Address

    Intern Experience Reporting (PDF) - During the COVID-19 pandemic, please scan your form and attach it to a ticket that you create.  Log in to your PALS account at www.pals.pa.gov and click on the comment bubble located to the right of your pharmacy intern registration number under the "Professional License Details" banner.  You may also create a ticket by clicking on the "Support" link on the top blue banner at www.pals.pa.gov.  The Board office staff will respond to your ticket.  Do NOT mail the form/submit a postcard.

    Request Verification of Intern Hours (PDF)

    Verification of licensure to another state - request ONLINE

    NOTE:  As a result of document fraud and in an effort to protect its licensees, the Board will only provide direct source verification of your license to another state licensing agency.

    Management of Drug Therapy - Professional Liability Insurance for the Institutional Setting (PDF)

    Management of Drug Therapy - Professional Liability Insurance for the Non-Institutional Setting (PDF)

    Pharmacy Closure Notice (PDF)

    Instructions for Reciprocating (PDF) 

    Act 114 Authorization to Administer Repackaged and Relabeled Medications Form (PDF)

    Act 114 Prescriber Consent Form (PDF)